Microsurgical excision of a compressive thoracic arachnoid cyst: Technical pearls.
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ABSTRACT:
SUBMITTER: Glauser G
PROVIDER: S-EPMC6878065 | biostudies-literature | 2019 Nov
REPOSITORIES: biostudies-literature
Publications
Microsurgical excision of a compressive thoracic arachnoid cyst: Technical pearls.
Glauser Gregory G Petrov Dmitriy D Choudhri Omar O
Clinical case reports 20190912 11
The key clinical message of this case is that it is critical to differentiate between arachnoid cysts and spinal cord herniation. This is performed by evaluating the ventral dura to assure that it remains intact. ...[more]
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Project description:Introduction:Spinal extradural arachnoid cysts (SEACs) are rare expansive lesions that account for ~1% of all spinal tumors. They develop as the result of arachnoid membrane herniation through a small dural defect and are mostly reported to be located at lower thoracic region and thoracolumbar junction. Case presentation:We report a rare case of SEAC located in the cervicothoracic junction causing neurologic compression. Discussion:Only 3% of all SEACs are observed in the cervical spine. They are the most common in young men and present with compressive symptoms. SEACs have potential to enlarge. As they are surgically removable lesions, early and definite diagnosis is important in preventing clinical deterioration. MRI is recommended for the diagnosis and preoperative planning.
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Project description:BackgroundIntracranial arachnoid cysts are usually benign congenital findings of neuroimaging modalities, sometimes however, leading to focal neurological and psychiatric comorbidities. Whether primarily clinically silent cysts may become causally involved in cognitive decline in old age is neither well examined nor understood.Case presentationA 66-year old caucasian man presenting with a giant left-hemispheric frontotemporal cyst without progression of size, presented with slowly progressive cognitive decline. Neuropsychological assessment revealed an amnestic mild cognitive impairment (MCI) without further neurological or psychiatric symptoms. The patient showed mild medio-temporal lobe atrophy on structural MRI. Diffusion tensor and functional magnetic resonance imaging depicted a rather sustained function of the strongly suppressed left hemisphere. Amyloid-PET imaging was positive for increased amyloid burden and he was homozygous for the APOEε3-gene. A diagnosis of MCI due to Alzheimer's disease was given and a co-morbidity with a silent arachnoid cyst was assumed. To investigate, if a potentially reduced CSF flow due to the giant arachnoid cyst contributed to the early manifestation of AD, we reviewed 15 case series of subjects with frontotemporal arachnoid cysts and cognitive decline. However, no increased manifestation of neurodegenerative disorders was reported.ConclusionsWith this case report, we illustrate the necessity of a systematic work-up for neurodegenerative disorders in patients with arachnoid cysts and emerging cognitive decline. We finally propose a modus operandi for the stratification and management of patients with arachnoid cysts potentially susceptive for cognitive dysfunction.
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