Description
Intracranial arachnoid cysts are congenital malformations with a predilection for the middle cranial fossa and an estimated prevalence in the general population as high as 1.7%. The common assumption is that these cysts are incidental findings and the symptoms associated with them are not caused by the cyst and consequently, that surgical intervention will not benefit the patient. However, there is now a growing understanding reflected in the international literature among neurologists and neurosurgeons that arachnoid cysts do harm and that the patients’ complaints can be relieved by surgical treatment.
Arachnoid Cysts: Epidemiology, Biology, and Neuroimaging gives a broad and updated presentation of the condition, including epidemiology, etiology, biology (including genetics and molecular biology), and neuroimaging of same. This book is written for researchers, residents, and clinical practitioners in clinical neuroscience, neurology, neurosurgery, neuroradiology, and pediatrics.
- Gives a detailed account of all pathophysiological aspects of arachnoid cysts
- Covers epidemiology, etiology, biology, genetics and molecular biology and neuroimaging of arachnoid cysts
- Discusses present controversies in cyst management in a historical perspective
- Provides information of use to researchers, residents, and clinical practitioners in clinical neuroscience, neurology, neurosurgery, neuroradiology, and pediatrics
Chapter
1 Arachnoid Cysts—Historical Perspectives and Controversial Aspects
The First Observation and Description of an AC
Where Were the Early Cysts Located?
Arachnoid Cysts and Imaging
Skull X-Ray and Angiograms
Arachnoid Cysts: Controversies and Misconceptions
The Reluctance to Operate ACs—Can It Be Explained From the History?
The Big Mistake—The Temporal Lobe Agenesis Syndrome
2 Arachnoid Cysts—Intracranial Locations, Gender, and Sidedness
Anatomical Location, Sidedness, and Gender Distribution in Large Series of AC Patients
Anatomical Location of ACs
3 Molecular Biology and Genetics: Gene Expression, Twin Studies and Familial Occurrence, and Syndromes Associated With AC
Syndromes Associated With Arachnoid Cysts
Twin Studies and Familial Occurrence
Studies on Gene Expression
4 Arachnoid Cysts in Glutaric Aciduria Type I (GA-I)
Pathophysiologic Concepts
Clinical Presentation and Natural Disease Course
Neuroradiologic Abnormalities
Subdural Hemorrhage and Arachnoid Cysts in GA-I
5 Ultrastructure of Arachnoid Cysts
Ultrastructure of the Arachnoid Membrane
Immunohistochemistry of AC
ACs With Arachnoid-Like Morphology (Type I)
Arachnoid Cysts With Fibrous Morphology (Type II)
Arachnoid Cysts With Aberrant Morphology (Type III)
6 Pathophysiology of Intracranial Arachnoid Cysts: Hypoperfusion of Adjacent Cortex
Influence of Arachnoid Cyst on Brain Function
Intracranial Hypertension
Altered Cerebral Perfusion and Metabolism
MR Imaging Characteristics in DWI
Functional MR Imaging in ACs
7 Biochemistry—Composition of and Possible Mechanisms for Production of Arachnoid Cyst Fluid
Theories of Filling Mechanism
Osmotic Pressure Mechanism
Recommendations—Level of Evidence
Communication With Subarachnoid Space
III. Prevalence and Natural History of Arachnoid Cysts
9 The Prevalence of Intracranial Arachnoid Cysts
10 Classification and Location of Arachnoid Cysts
Classification of Middle Fossa Temporal Cysts—Galassi Classification
11 Growth and Disappearance of Arachnoid Cysts
Recommendations—Level of Evidence
Spontaneous Disappearance or Reduction of Cysts
Postnatal Development of De Novo ACs and Growth of an Established AC
Postnatal Development of De Novo ACs
Postnatal Growth of an Already Established AC
12 Arachnoid Cysts and Subdural and Intracystic Hematomas
What Is The Frequency/Prevalence of Extracerebral Hematomas in AC Patients?
How Often are ACs Found in Patients With a CSDH and Where Are These Cyst Located?
How Often Are Chronic Extracerebral Hematomas Found in Patients With an AC and Which Cyst Locations Predispose for Such Hem...
Should We Then Operate Arachnoid Cysts to Prevent the Development of Future Hematomas?
Who Are at Risk of Getting Spontaneous Hematomas Associated With an AC?
Age Doesn’t Seem to Matter
Cyst Location—Middle Fossa Cysts Are Overrepresented in Patients With Extracerebral Hematomas
What Are the Possible Mechanisms Behind the Bleeding?
How Dangerous Are Spontaneous Extracerebral Hematomas in AC Patients?
Which Surgical Procedures Have Been Used?
Intracranial Aneurysms and AC - Is There an Association?
Can Extracerebral Hematomas in AC Patients Be Misinterpreted as Having Been Caused by Physical Child Abuse?
13 Hydrocephalus Associated With Arachnoid Cysts
Embryopathogenesis of AC-Related Hydrocephalus
ACs and the Subarachnoid Spaces
Pathogenesis of AC-Associated Hydrocephalus
Epidemiological Data of ACs With Hydrocephalus
Arachnoid Cyst-Related Hydrocephalus
Significance of Macrocephaly in ACs
Hydrocephalus Associated With ACs
Diagnosis of AC-Related Hydrocephalus
Management Options for Hydrocephalus in ACs
Surgical Management Options
Surgical Options According to AC Location
14 Radiological Workup, CT, MRI
Recommendations—Level of Evidence
Magnetic Resonance Imaging
15 Arachnoid Cyst—Prenatal Detection, Management, and Perinatal Outcome
Recommendations—Level of Evidence
Outcome of Arachnoid Cysts
16 SPECT Studies in Patients With Arachnoid Cysts
Significance of Functional Studies for Deciding AC Surgery
Isotope-Based Studies in the Assessment of AC Pathology