Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region

详细信息    查看全文

• 作者：Liyong Sun ; Stephan Emich ; Wenzhuo Fu ; Zan Chen ; Wu Hao ; Feng Ling…
• 关键词：Arachnoid cyst ; Cerebrospinal fluid circulation ; Foramen magnum ; Posterior fossa ; Microsurgical fenestration ; Syringomyelia
• 刊名：Neurosurgical Review
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：39
• 期：2
• 页码：341-347
• 全文大小：3,596 KB
• 参考文献：1.Apok V, Constantini S, Roth J (2012) Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia. Childs Nerv Syst 28:653–656CrossRef PubMed
  2.Arai H, Sato K (1991) Posterior fossa cysts: clinical, neuroradiological and surgical features. Childs Nerv Syst 7:156–164CrossRef PubMed
  3.Arunkumar MJ, Korah I, Chandy MJ (1998) Dynamic CSF flow study in the pathophysiology of syringomyelia associated with arachnoid cysts of the posterior fossa. Br J Neurosurg 12:33–36CrossRef PubMed
  4.Banna M (1988) Syringomyelia in association with posterior fossa cysts. AJNR Am J Neuroradiol 9:867–873PubMed
  5.Bauer AM, Mueller DM, Oro JJ (2005) Arachnoid cyst resulting in tonsillar herniation and syringomyelia in a patient with achondroplasia. Case report. Neurosurg Focus 19, E14CrossRef PubMed
  6.Conti C, Lunardi P, Bozzao A, Liccardo G, Fraioli B (2003) Syringomyelia associated with hydrocephalus and Blake’s pouch cyst: case report. Spine (Phila Pa 1976) 28:E279–E283
  7.Duddy JC, Allcutt D, Crimmins D, O’Brien D, O’Brien DF, Rawluk D, Sattar MT, Young S, Caird J (2014) Foramen magnum decompression for Chiari I malformation: a procedure not to be underestimated. Br J Neurosurg 28:330–334CrossRef PubMed
  8.Ellenbogen RG, Armonda RA, Shaw DW, Winn HR (2000) Toward a rational treatment of Chiari I malformation and syringomyelia. Neurosurg Focus 8, E6CrossRef PubMed
  9.Filippi R, Schwarz M, Voth D, Reisch R, Grunert P, Perneczky A (2001) Bovine pericardium for duraplasty: clinical results in 32 patients. Neurosurg Rev 24:103–107CrossRef PubMed
  10.Galarza M, Lopez-Guerrero AL, Martinez-Lage JF (2010) Posterior fossa arachnoid cysts and cerebellar tonsillar descent: short review. Neurosurg Rev 33:305–314, discussion 314CrossRef PubMed
  11.Gardner WJ, Angel J (1958) The mechanism of syringomyelia and its surgical correction. Clin Neurosurg 6:131–140PubMed
  12.Heiss JD, Snyder K, Peterson MM, Patronas NJ, Butman JA, Smith RK, Devroom HL, Sansur CA, Eskioglu E, Kammerer WA, Oldfield EH (2012) Pathophysiology of primary spinal syringomyelia. J Neurosurg Spine 17:367–380CrossRef PubMed PubMedCentral
  13.Hirano T, Kawamura T, Itoh J, Kanayama S (1999) A rare case of trapped fourth ventricle: an unique symptom appeared after fourth ventriculo-peritoneal shunting. No To Shinkei 51:247–251PubMed
  14.Huang H, Li Y, Xu K, Qu L, Yu J (2011) Foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia: case report and literature review. Int J Med Sci 8:345–350CrossRef PubMed PubMedCentral
  15.Jain R, Sawlani V, Phadke R, Kumar R (2000) Retrocerebellar arachnoid cyst with syringomyelia: a case report. Neurol India 48:81–83PubMed
  16.Joshi VP, Valsangkar A, Nivargi S, Vora N, Dekhne A, Agrawal A (2013) Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia. J Craniovertebr Junction Spine 4:43–45CrossRef PubMed PubMedCentral
  17.Kiran NA, Kasliwal MK, Suri A, Mahapatra AK (2010) Giant posterior fossa arachnoid cyst associated with syringomyelia. Clin Neurol Neurosurg 112:454–455CrossRef PubMed
  18.Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX (2004) Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure: a clinical review of 1 year. Neurosurgery 54:599–603, discussion 603–594CrossRef PubMed
  19.Marin SA, Skinner CR, Da Silva VF (2010) Posterior fossa arachnoid cyst associated with Chiari I and syringomyelia. Can J Neurol Sci 37:273–275CrossRef PubMed
  20.Martinez-Lage JF, Ruiz-Espejo A, Guillen-Navarro E, Almagro MJ (2008) Posterior fossa arachnoid cyst, tonsillar herniation, and syringomyelia in trichorhinophalangeal syndrome Type I. J Neurosurg 109:746–750CrossRef PubMed
  21.Milhorat TH (2000) Classification of syringomyelia. Neurosurg Focus 8, E1CrossRef PubMed
  22.Nomura S, Akimura T, Imoto H, Nishizaki T, Suzuki M (2002) Endoscopic fenestration of posterior fossa arachnoid cyst for the treatment of presyrinx myelopathy--case report. Neurol Med Chir (Tokyo) 42:452–454CrossRef
  23.Oldfield EH, Muraszko K, Shawker TH, Patronas NJ (1994) Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 80:3–15CrossRef PubMed
  24.Pang D, Zwienenberg-Lee M, Smith M, Zovickian J (2005) Progressive cranial nerve palsy following shunt placement in an isolated fourth ventricle: case report. J Neurosurg 102:326–331PubMed
  25.Shinoda S, Tanaka K, Kawaguchi K (1998) A huge retrocerebellar arachnoid cyst with syringomyelia: case report. No Shinkei Geka 26:363–367PubMed
  26.Siccardi D, Ventimiglia A (1995) Fibrotic-haemorrhagic reaction to synthetic dural substitute. Acta Neurochir (Wien) 132:148–149CrossRef
  27.Thakar S, Dadlani R, Tawari M, Hegde AS (2013) Atypical cerebellar slump syndrome and external hydrocephalus following craniocervical decompression for Chiari I malformation: case report. Neurol Med Chir (Tokyo)
  28.Thompson D, Taylor W, Hayward R (1994) Haemorrhage associated with silastic dural substitute. J Neurol Neurosurg Psychiatry 57:646–648CrossRef PubMed PubMedCentral
  29.Tokime T, Okamoto S, Yamagata S, Konishi T (1997) Syringomyelia associated with a posterior fossa cyst. Illustration of two cases. J Neurosurg 86:907CrossRef PubMed
  
• 作者单位：Liyong Sun (1)
  Stephan Emich (2)
  Wenzhuo Fu (3)
  Zan Chen (1)
  Wu Hao (1)
  Feng Ling (1)
  Fengzeng Jian (1)
  
  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, 100053, China
  2. Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical Private University (PMU), Ignaz Harrer Street 79, 5020, Salzburg, Austria
  3. Medical experiments and testing center, Capital Medical University, Xitoutiao Street 10, Beijing, 100069, China
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Neurosurgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1437-2320

文摘

A retrocerebellar arachnoid cyst causing syringomyelia is extremely rare without tonsillar herniation. The authors present a 44-year-old woman with symptoms of foramen magnum compression and syringomyelia. Magnetic resonance imaging demonstrated a large retrocerebellar arachnoid cyst with a large cervicothoracic syrinx but no signs of tonsillar herniation or hydrocephalus. The patient underwent a foramen magnum decompression with C1 laminectomy, microsurgical fenestration of the cyst, and duraplasty. After successful reconstruction of CSF flow, the patient experienced a relief of symptoms and a significant reduction of the syrinx. The intraoperative findings support the theory of a piston mechanism in the development of syringomyelia. Additional arachnoidal adhesions may also obstruct the CSF flow around the craniocervical junction. We recommend the surgical treatment should consist of an adequate decompression of the foramen magnum, wide microsurgical arachnoidal debridement, and duraplasty with autologous grafts sutured in a watertight way.