Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia

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Abstract

Acquired cerebellar tonsillar herniation and syringomyelia associated with posterior fossa mass lesions is an exception rather than the rule. In the present article, we describe the neuroimaging findings in a case of 28-year-old female patient presented with a history of paraesthesia involving right upper limb of 8-month duration. Magnetic resonance imaging showed a giant retrocerebellar arachnoid causing tonsillar herniation with cervical syringomyelia. The findings in the present case supports that the one of the primary mechanism for the development of syringomyelia may be the obstruction to the flow of cerebrospinal fluid causing alterations in the passage of extracellular fluid in the spinal cord and leading to syringomyelia.

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Most cited references 20

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Intracranial arachnoid cysts: current concepts and treatment alternatives.

Amit Agrawal, José Eiras, Rafael Cincu (2007)

Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1% of all intracranial space-occupying lesions. In this article, we review the current concepts about these lesions and discuss the treatment alternatives. The aetiology of arachnoid cysts has been a controversial subject. They are regarded as developmental abnormality of the arachnoid, originating from a splitting or duplication of this membrane. The establishment of a single CSF space, by surgically communicating the cyst with the ventricular system or basal cisterns, appears to offer the best chance of a success in the treatment of arachnoid cysts. Long-term prognosis for patients with arachnoid cysts and well-preserved neurological conditions is good, even in the case of subtotal excision. Clinical follow-up and MRI allow earlier diagnosis of recurrence.

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Surgery for syringomyelia: an analysis based on 163 surgical cases.

Dhwani Desai, Shakti Goel (1999)

The authors analyzed the cases of 163 patients with syringomyelia to assess the appropriate surgical procedure. Depending on the aetiological factors and treatment considerations the series was classified into three groups. Group I were cases where there was no definite demonstrable aetiological factor; Group II cases had basilar invagination and/or Chiari malformation; and Group III consisted of cases where the syrinx was secondary to an obvious aetiology, such as a mass lesion either in the posterior cranial fossa or in the spine or a severe kyphotic spinal deformity. Post-traumatic syringomyelia and syrinx in association with spina bifida were not studied. We concluded that for Group I cases syringosubarachnoid shunting is the ideal form of treatment. In Group II cases foramen magnum bony decompression is satisfactory and physiological. Good results were obtained even in cases where either a foramen magnum decompression alone or in combination with a syringo-subarachnoid shunt was done. Only syringosubarachnoid shunt (without a foramen magnum decompression) in Group II cases was found to produce poor outcome. Group III cases should be treated for the primary aetiological problem. Only syrinx drainage procedure without treatment of aetiology in these cases produced poor results. It was observed that clinical outcome rather than radiological improvement is the reliable indicator of the surgical result.

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Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance.

P Pillay, E Penner, Susan Little … (1991)

Thirty-five consecutive adults with Chiari malformation and progressive symptoms underwent surgical treatment at a single institution over a 3-year period. All patients underwent magnetic resonance imaging scan before and after surgery. Images of the craniovertebral junction confirmed tonsillar herniation in all cases and allowed the definition of two anatomically distinct categories of the Chiari malformation in this age group. Twenty of the 35 patients had concomitant syringomyelia and were classified as Type A. The remaining 15 patients had evidence of frank herniation of the brain stem below the foramen magnum without evidence of syringomyelia and were labeled Type B. Type A patients had a predominant central cord symptomatology; Type B patients exhibited signs and symptoms of brain stem or cerebellar compression. The principal surgical procedure consisted of decompression of the foramen magnum, opening of the fourth ventricular outlet, and plugging of the obex. Significant improvement in preoperative symptoms and signs was observed in 9 of the 20 patients (45%) with syringomyelia (Type A), as compared to 13 of the 15 patients (87%) without syringomyelia (Type B). Postoperative reduction in syrinx volume was observed in 11 of the 20 patients with syringomyelia, including all 9 patients with excellent results. Magnetic resonance imaging has allowed a classification of the adult Chiari malformation in adults based on objective anatomic criteria, with clinical and prognostic relevance. The presence of syringomyelia implies a less favorable response to surgical intervention.

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Author and article information

Journal

Journal ID (nlm-ta): J Craniovertebr Junction Spine

Journal ID (iso-abbrev): J Craniovertebr Junction Spine

Journal ID (publisher-id): JCVJS

Title: Journal of Craniovertebral Junction and Spine

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0974-8237

ISSN (Electronic): 0976-9285

Publication date (Print): Jan-Jun 2013

Volume: 4

Issue: 1

Pages: 43-45

Affiliations

[1]Department of Neurosurgery, Anesthesia and Pathology, SP Institute of Neurosciences, Solapur, Maharashtra, India

[1 ]Department of Neurology, Anesthesia and Pathology, SP Institute of Neurosciences, Solapur, Maharashtra, India

[2 ]Department of Pathology, Yashodhara Super Speciality Hospital, Solapur, Maharashtra, India

[3 ]Department of Neurosurgery, Narayana Medical College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Author notes

Corresponding author: Dr. Amit Agrawal, Department of Neurosurgery, Narayana Medical College & Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh, India. E-mail: dramitagrawal@ 123456gmail.com

Article

Publisher ID: JCVJS-4-43

DOI: 10.4103/0974-8237.121627

PMC ID: 3872663

PubMed ID: 24381458

SO-VID: fa0b5455-7d17-48d7-b8f1-63970aaf7a43

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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.

Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia

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Karger: Neurology and Neuroscience

Most cited references 20

Intracranial arachnoid cysts: current concepts and treatment alternatives.

Surgery for syringomyelia: an analysis based on 163 surgical cases.

Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance.

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