Mise au point sur le kyste arachnoïdien intrasellaire: à propos d’un cas

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Abstract

Les kystes arachnoïdiens intrasellaires sont des malformations bénignes. La localisation intrasellaire est extrêmement rare de l’ordre de 3%. Leur physiopathologie est encore mal élucidée. Nous rapportons un cas de kyste arachnoïdien intrasellaire à expansion suprasellaire dont la prise en charge avait consisté en une fenestration endoscopique par voie transsphénoïdale. Les aspects épidémiologiques, cliniques, physiopathologiques, radiologiques, thérapeutiques et évolutifs ont été analysés. Les procédures neuroendoscopiques sont de plus en plus utilisées pour la prise en charge chirurgicale. Leur pronostic est bon, et la récidive fréquente même après plusieurs années d’évolution.

Translated abstract

Intrasellar arachnoid cysts are benign malformations. They are extremely rare (approximately 3% of cases). Their pathophysiology is still poorly elucidated. We here report a case of intrasellar arachnoid cyst with suprasellar extension whose treatment was based on endoscopic transsphenoidal fenestration. The epidemiological, clinical, pathophysiological, radiological, therapeutic and evolutionary features have been analyzed. Neuroendoscopic procedures are performed with increasing frequency in surgery. Prognosis is good and recurrences are frequent, even after several years of evolution.

Most cited references 21

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Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers.

Alain Dagher, Joanna Katzman, N Patronas (1999)

Previous reports have discussed incidental disease found on brain magnetic resonance imaging (MRI) scans that had been requested for an unrelated clinical concern or symptom, resulting in a selection bias for disease. However, the prevalence of unexpected abnormalities has not been studied in a healthy population. To evaluate the prevalence of incidental findings on brain MRI scans obtained for a healthy, asymptomatic population without selection bias. Retrospective analysis of brain MRI scans obtained between May 17, 1996, and July 25, 1997, from 1000 volunteers who participated as control subjects for various research protocols at the National Institutes of Health. All participants (age range, 3-83 years; 54.6% male) were determined to be healthy and asymptomatic by physician examination and participant history. Prevalence of abnormalities on brain MRI by category of finding (no referral necessary, routine referral, urgent referral [within 1 week of study], and immediate referral [within 1 to several days of study]). Eighty-two percent of the MRI results were normal. Of the 18% demonstrating incidental abnormal findings, 15.1% required no referral; 1.8%, routine referral; 1.1%, urgent referral; and 0%, immediate referral. In subjects grouped for urgent referral, 2 confirmed primary brain tumors (and a possible but unconfirmed third) were found, demonstrating a prevalence of at least 0.2%. Asymptomatic subjects present with a variety of abnormalities, providing valuable information on disease prevalence in a presumed healthy population. A small percentage of these findings require urgent medical attention and/or additional studies.

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Incidental findings in magnetic resonance imaging of the brains of healthy young men.

Frank Weber, H Knopf (2006)

To determine the frequency of serious intracranial abnormalities in a healthy young male population. Cranial MRI of 2,536 healthy young males, mean age 20.5 years, all applicants for military flying duties in the German Air Force. The authors report a variety of morphological abnormalities in the brains of a large population of healthy young males, providing data on disease prevalence. Arachnoid cysts were found in 1.7% (95% CI 1.2 to 2.3%), vascular abnormalities in 0.51% (95% CI 0.29 to 0.9%), and intracranial tumors in 0.47% (95% CI 0.26 to 0.85%) of the applicants. No cerebral aneurysms were found. The prevalence of primary brain tumors seems to be higher, whereas the prevalence of intracranial aneurysms is lower than expected. Only a small percentage of the detected abnormalities require urgent medical attention.

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Ultrastructure and pathogenesis of intracranial arachnoid cysts.

S S Rengachary, I. Watanabe (1980)

A detailed light, transmission, and scanning electron microscopic study of the arachnoid cyst wall was made in four cases and compared with that of the normal arachnoid mater in the human. Two hundred and eight reported cases of arachnoid cysts were analyzed to evaluate the anatomical distribution of these lesions and to get r an insight into their pathogenesis. The structural features of the arachnoid cyst wall that distinguish it from the normal arachnoid membrane are as follows: (1) splitting of the arachnoid membrane at the margin of the cyst, (2) a very thick layer of collagen in the cyst wall, (3) the absence of traversing trabecular processes within the cyst, and (4) the presence of hyperplastic arachnoid cells in the cyst wall, which presumably participate in collagen synthesis. The distribution of arachnoid cysts in two hundred and eight reported cases was as follows: Sylvian fissure, 49%; cerebellopontine angle, 11%; supracollicular area, 10%; the vermis, 9%; sellar and suprasellar area, 9%; interhemispheric fissure, 5%; cerebral convexity, 4%; and the clival and interpeduncular area, 3%. At each site, except possibly on the cerebral convexity, the cyst was associated with a normal subarachnoid cistern. This striking and nearly invariable association of arachnoid cysts with normal subarachnoid cisterns prompts the authors to hypothesize that arachnoid cysts represent a congenital anomaly of the developing subarachnoid cisterns in early intrauterine life. It is postulated that, during the process of the complex folding of the primitive neural tube and the formation of normal subarachnoid cisterns, an anomalous splitting of the arachnoid membrane occurs.

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Author and article information

Journal

Journal ID (nlm-ta): Pan Afr Med J

Journal ID (iso-abbrev): Pan Afr Med J

Journal ID (publisher-id): PAMJ

Title: The Pan African Medical Journal

Publisher: The African Field Epidemiology Network

ISSN (Electronic): 1937-8688

Publication date (Electronic): 27 September 2019

Publication date Collection: 2019

Volume: 34

Electronic Location Identifier: 55

Affiliations

[1 ]Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal

[2 ]Service de Neurochirurgie, Hôpital Général de Grand Yoff, Dakar, Sénégal

Author notes

[& ]Auteur correspondant: Maguette Mbaye, Service de Neurochirurgie, Centre Hospitalier National Universitaire de Fann, Université Cheikh Anta Diop, Dakar, Sénégal

Article

Publisher ID: PAMJ-34-55

DOI: 10.11604/pamj.2019.34.55.18564

PMC ID: 6859025

SO-VID: 098256e4-0821-4bd5-b003-45024b7b2fda

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The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mise au point sur le kyste arachnoïdien intrasellaire: à propos d’un cas Translated title: Update on intrasellar arachnoid cyst: a case study

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Abstract

Translated abstract

Most cited references 21

Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers.

Incidental findings in magnetic resonance imaging of the brains of healthy young men.

Ultrastructure and pathogenesis of intracranial arachnoid cysts.

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