Temporal Arachnoid Cysts, EEG Findings and Seizure Types

Öz

Aim: Arachnoid cysts are benign developmental anomalies. They are frequently located in the middle cranial fossa. Common clinical findings are cranial enlargement, hydrocephaly, headache, epileptic seizures, psychomotor retardation and aphasia. It is not known whether there is any correlation between intracranial AC and epileptic seizures. The aim of our study was to determine the association between temporal AC and epilepsy in epileptic patients with AC localized to the temporal region by evaluating the type of seizures, interictal EEG findings, any concurrent epileptogenic pathology and the response to medication. Material and Methods: Nine cases with AC of the temporal lobe were included in the study. The ages of the patients (2 females, 7 males) varied from 6 to 54 (mean age: 25.5 ±13.6) . Results: The arachnoid cyst was localized in the left temporal lobe in six patients, right temporal lobe in two patients and in both the right and left temporal lobes in one patient. The type of seizure was generalized tonic clonic (GTC) in six patients, simple partial progressing to generalized seizures in one patient, Juvenile Myoclonic Epilepsy (JME) in one patient and simple partial seizures with motor findings in one patient. The interictal EEG was normal in four patients. Two patients had generalized spike-wave activity, two patients with left temporal lobe AC had a right temporal focus and one patient showed epileptiform activity. Conclusion: The findings of our study supported the notion that the concurrence of AC and epilepsy was incidental and also failed to show an association between AC and a specific type of epilepsy. Key words: Temporal arachnoid cysts, EEG, epilepsy

Anahtar Kelimeler

• Temporal arachnoid cysts, EEG, epilepsy

Temporal Araknoid Kistler, EEG Bulguları Ve Nöbet Tipleri

Öz

Araknoid kistler (AK) benign gelişimsel anomalilerdir ve sıklıkla orta kraniyal fossada yerleşirler. Oluşturdukları klinik bulgulardan en sık rastlanılanları, kraniyal genişleme, hidrosefali, başağrısı, epileptik nöbetler, psikomotor retardasyon ve afazidir. İntrakranial basınç artma bulguları ve/veya diğer nörolojik bulgulara yol açmamış olan intrakranial AK ile epileptik nöbetler arasında ilişki olup olmadığı bilinmemektedir. Çalışmamızın amacı, emporal bölgede yerleşmiş araknoid kisti olan epileptik hastalarda, nöbet tipi, interiktal elektroensefalografi bulguları, araknoid kistlerin olası epileptojenik potansiyelleri ve hastaların tedaviye yanıtları arasında ilişki olup olmadığını tanımlamaktı. Çalışmaya temporal bölgede araknoid kisti olan 6-54 yaşlar arasında (ortalama yaş 25.5±13.6) 9 olgu alındı. Araknoid kist lokalizasyonu altı hastada sol temporal, iki hastada sağ temporal ve bir hastada sağ ve sol temporal yerleşimliydi. Altı hastanın nöbeti GTK tip, biri jeneralize nobetlere ilerleyen basit parsiyel, biri JME ve biri de motor bulgulu basit parsiyel nöbetti. Dört hastada interiktal EEG normaldi. İki hastada jeneralize diken-dalga aktivitesi, sol temporal bölgede AK olan iki hastada sağ temporal odak ve bir hastada epileptiform aktivite vardı. Sekiz hasta monoterapi alırken iki taraflı temporal AK olan bir hasta politerapi alıyordu ve nöbetler tedaviye dirençliydi. Bulgularımız epilepsili olgularda araknoid kistin insidental olduğunu ve araknoid kist ile spesifik bir epilepsi tipi arasında ilişki olmadığını destekledi. Anahtar kelimeler: Temporal araknoid kistler, Epilepsi, Interiktal EEG bulguları

Anahtar Kelimeler

• Temporal araknoid kistler, Epilepsi, Interiktal EEG bulguları

Kaynakça

1. Acar O, Karacaoğullar Y, Güney Ö. Arachnoid cyst within the fourth ventricle: a case report. Clin Neuro Neurosurg 2003; 105:93-94.
2. Tsitouridis I, Papastergiou C, Emmanouilidou M, Goutsaridou F, Chondromatidou S, Eleni T. Arachnoid cyst of the frontal part of the temporal lobe producing exopthtalmos CT and MRI evaluation. Clin Imaging 2002;26:302– 305.
3. Gosalakkal JA. Intracranial arachnoid cysts in children: A review of pathogenesis, clinical features, and management. Pediatr Neurol 2002;26:93-98.
4. Samii M, Carvalho AG, Schuhmann MU. Matthies C. Arachnoid Cysts Of The Posterior Fossa. Surg Neurol 1999;51:376–82.
5. Wang P, Lin H, Liu H, Tseng C, Shen Y. Intracranial Arachnoid Cysts in Children: Related Signs and Associated Anomalies. Pediatr Neurol 1998;19:100-104.
6. Suzuki H ,Takanashi J, Sugita K, Barkovich AJ, Kohno Y. Retrocerebellar arachnoid cysts in siblings with mental retardation and undescended testis. Brain Dev 2002;24:310–313
7. Kawamura T, Morioka T, Nishio S, Fukui K, Yamasaki R, Matsuo M. Temporal lobe epilepsy associated with hippocampal sclerosis and a contralateral middle fossa arachnoid cyst. Seizure 2002;11:60–62.
8. Okada Y, Hamano K, Iwasaki N, Horigome Y, Enomoto T, Sato M, et al. Epilepsy Accompanied by Intracranial Arachnoid Cysts: Studies on Volume and Regional Cerebral Blood Perfusion Using MRI and SPECT. J Epilepsy 1998;11:195–201.

9. Sener RN. Arachnoid cysts associated with post-traumatic and spontaneous rupture into the subdural space. Comput Med Imaging and Graph 1997;21:341-344.
10. Yamasaki F, Kodama Y, Hotta T, Taniguchi E, Eguchi K, Yoshioka H, et al. Interhemispheric Arachnoid Cyst in the Elderly: Case Report and Review of the Literature. Surg Neurol 2003;59:68–74.
11. Wester K, Svendsen F, Hugdahl K. Intracranial arachnoidal cysts Localization,gender and sidedness. Tidsskr-Nor-Laegeforen 1999;119(28):4162–1164.
12. Arroya S, Santamaria J. What is the relationship between arachnoid cysts and seizure foci ? Epilepsia 1997;38:1098-1102.
13. Pascual-Castroviejo I, Pascual-Pascual SI. Bilateral arachnoid cysts, seizures and severe encephalopathy: Case report. Neuropediatrics 1994;25:42-43.
14. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 30:389-399, 1989.
15. Galarza M, Pomata HB, Pueyrredon F, Bartuluchi M, Zuccaro NG, Jorge AM. Symptomatic Supratentorial Arachnoid Cysts in Children. Pediatr Neurol 2002;27:180-185.
16. De Volder AG, Michel C, Thauvoy C, Willems G, Ferriere G. Brain glucose utilization in acquired childhood aphasia associated with a sylvian arachnoid cyst: Recovery after shunting as demonstrated by PET. J Neurol Neurosurg Psychiatry 1994;57:296 –300.
17. Wester K. Gender distribution and sidedness of middle fossa arachnoid cysts: a review of cases diagnosed with computed imaging. Neurosurgery 1992;31:940-944.
18. Stowe LA, Go KG, Pruim J, den Dunnen W, Meiners LC, Paans AMJ. Language Localization in Cases of Left Temporal Lobe Arachnoid Cyst: Evidence against Interhemispheric Reorganization. Brain Lang 2000;75:347–358.
19. Soukupa VM, Pattersonb J, Trierb TT, Chen JW. Cognitive improvement despite minimal arachnoid cyst decompression. Brain Dev 1998;20:589–593.
20. Oberbauer RW, Haase J, Pucher R. Arachnoid cysts in children: A European co- operative study. Childs Nerv Syst 1992;8:281– 6.
21. Weaster K. Peculiarities of intracranial arachnoid cysts: Location, sidedness, and sex distribution in 126 consecutive patients. Neurosurgery 1999;45:75-9.
22. Krupp W, Dohnert J, Kellermann S, Seifert V. Intradiploic arachnoid cyst with extensive deformation of craniofacial osseous structures: Case report. Neurosurgery 1999;44:868-70.
23. Kramer U, Nevo Y, Reider-Groswasser I, Sheuer E, Meyer JJ, Leitner Y, Phatal A, Harel S. Neuroimaging of children with partial seizures. Seizures 1998;7:115-8.
24. Koch CA, Moore JL, Voth D. Arachnoid cysts: How do postsurgical cyst size and seizure outcome correlate? Neurosurg Rev 1998; 21:14-22.
25. Morioka T, Nishio S, Ishibashi H, Fukui M, Narazaki O. Relationship between arachnoid cysts and seizure foci. Epilepsia (Letters) 1989;39:804–806.
26. Bhandari YS. Non-communicating supratentorial subarachnoid cysts. J Neurol Neurosurg Psychiatry 1972;35: 763–70.
27. Yalçın AD, Öncel Ç, Kaymaz A, Kuloğlu N, Forta H. Evidence against association between arachnoid cysts and epilepsy. Epilepsy Res 2002;49:255–260.
28. Passero S, Filosomi G, Cioni R, Venturi C, Volpini B. Arachnoid cysts of the middle cranial fossa: A clinical, radiological and follow-up study. Acta Neurol Scand 1990;82:94 –100.
29. Brielman RS, Jackson GD, Torn-Broers Y, Berkovic SF. Twins with different temporal lobe malformations: schizencephaly and arachnoid cyst. Neuropediactrics 1998;29:284–288.
30. D’Angelo V, Gorgoglione L, Catapano G. Treatment of symptomatic intracranial arachnoid cysts by stereotactic cyst-ventricular shunting. Sterotact Funct Neurosurg 1999;72:62-9.
31. von Wild K. Arachnoid cysts of the middle cranial fossa. Neurochirurgia 1992;35:171– 82.
32. von der Meche, Braakman R. Arachnoid cysts in the middle cranial fossa: Cause and treatment of progressive and nonprogressive symptoms. J Neurol Neurosurg Psychiatry 1983; 46:1102–7.
33. Koch CA, Voth D, Kraemer G, Schwarz M. Arachnoid cysts: Does surgery improve epileptic seizures and headaches. Neurosurg Rev 1995;18:173-81.
34. Basauri L, Selman JM. Intracranial arachnoidal cysts. Childs Nervous System 1992;8:101–104.
35. Coe CJ, Lee YH. Organic disorder in children with epileptic seizures. Acta Paediatr Jpn 1989;31:267–72.
36. Tojo M, Sakai K. MR imaging of large heterotopic gray matter. No To Hattatsu 1989;21(3): 278 Abstract.
37. Naidich TP, McLone DG, Radkowski MA. Intracranial arachnoid cysts. Pediatr Neurosci 1986;12:112-22.
38. Go KG, Houthoff HJ, Blaauw EH, Havinga P, Hartsuiker J. Arachnoid cysts of the sylvian fissure: Evidence of fluid secretion. J Neurosurg 1984;60:803-13.
39. Rengachary SS, Watanabe I, Brackett CE. Pathogenesis of intracranial arachnoid cysts. Surg Neurol 1978;9:139-44.
40. Rengachary SS, Watanabe I. Ultrastructure and pathogenesis of intracranial cysts. J Neuropathol Exp Neurol 1981;40:61-83.
41. McLone DG, Boudareff W. Developmental morphology of the subarachnoid space and contiguous structures in the mouse. Am J Anat 1975;142:273-94.
42. Robinson RG. The temporal lobe agenesis syndrome. Brain 1964;87:87-110.
43. Parsh CS, Krauß J, Hofmann E, Meixensberger J, Rossen K. Arachnoid cysts associated with subdural hematomas and hygromas: Analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 1997;40:483-90.