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Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

INTRODUCTION AND AIM: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC. MATERIALS AND METHODS: We analyzed our case rec...

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Autores principales: Srinivasan, Uddanapalli Sreeramulu, Lawrence, Radhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352631/
https://www.ncbi.nlm.nih.gov/pubmed/25767579
http://dx.doi.org/10.4103/1793-5482.151512
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author Srinivasan, Uddanapalli Sreeramulu
Lawrence, Radhi
author_facet Srinivasan, Uddanapalli Sreeramulu
Lawrence, Radhi
author_sort Srinivasan, Uddanapalli Sreeramulu
collection PubMed
description INTRODUCTION AND AIM: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC. MATERIALS AND METHODS: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years. RESULTS: In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making. DISCUSSION: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.
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spelling pubmed-43526312015-03-12 Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series Srinivasan, Uddanapalli Sreeramulu Lawrence, Radhi Asian J Neurosurg Original Article INTRODUCTION AND AIM: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC. MATERIALS AND METHODS: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years. RESULTS: In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making. DISCUSSION: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4352631/ /pubmed/25767579 http://dx.doi.org/10.4103/1793-5482.151512 Text en Copyright: © Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Srinivasan, Uddanapalli Sreeramulu
Lawrence, Radhi
Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series
title Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series
title_full Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series
title_fullStr Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series
title_full_unstemmed Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series
title_short Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series
title_sort posterior fossa arachnoid cysts in adults: surgical strategy: case series
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352631/
https://www.ncbi.nlm.nih.gov/pubmed/25767579
http://dx.doi.org/10.4103/1793-5482.151512
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