The standard treatment for symptomatic spinal extradural arachnoid cyst (SEAC) is complete surgical removal of cyst and closure of the dural defect. In most cases, total laminectomy has been performed at affected vertebra for complete removal of the SEAC. However, this invasive surgery may result in postoperative kyphosis and back pain. We report a case of large SEAC involving T10-L1 which was excised through the minimal skipped hemilaminectomy, to minimize the risk of postoperative kyphotic deformity. Simultaneously, we closed the dural defect after preoperative precise identification of the site through several radiological studies.
Arachnoid ; Back Pain ; Congenital Abnormalities ; Kyphosis ; Laminectomy ; Spine

Optic sheath meningioma arises from the arachnoid "cap" cell of optic nerve sheath and comprises most of primary orbital meningioma. It usually brings early visual loss, papilledema, and proptosis. The authors expericenced a case of intraorbital optic sheath meningioma associated with a small skull hemangioma in the right parietal area, who presented only mild visual disturbance. The meningioma was removed transcranially without visual or cosmetic deformities except transient ptosis.
Arachnoid ; Congenital Abnormalities ; Exophthalmos ; Hemangioma* ; Meningioma* ; Optic Nerve ; Orbit ; Papilledema ; Rabeprazole ; Skull*

Terminal myelocystocele is a rare form of occult spinal dysraphism in which the hydromyelic caudal spinal cord and the subarachnoid space are hemiated through a posterior spina bifida. A 1.5 month old boy presented with a large lumbosacral mass and urinary incontinence. The magnetic resonance imaging, operative findings and pathological findings revealed a low lying conus with a dilated central canal dorsally attached to the subcutaneous tissue. Ventral subarachnoid space was enlarged and herniated through the laminar defect of the sacrum. The lesion was typical of a terminal myelocystocele. The clinical features are different from those of myelomeningocele in many aspects. Though the incidence is low, terminal myelocystocele should be included in the differential diagnosis of congenital lesions presenting as a lumbosacral mass.
Arachnoid/abnormalities ; Case Report ; Human ; Infant ; Lumbosacral Region ; Male ; Meningomyelocele/diagnosis/pathology/surgery ; Spinal Canal/abnormalities ; Spinal Cord/abnormalities ; *Spinal Dysraphism/diagnosis/pathology/surgery ; Support, Non-U.S. Gov't

The authors operated 17 cases out of 28 intracranial arachnoid cysts experienced from July, 1972 to August, 1981. The clinical analysis and surgical experiences were summarized as follows. The supratentorial cysts were 67.9% and the infratentorial cysts were 32.1% of the intracranial arachnoid cysts. The predilection sites were middle cranial fossa of the supratentorial(60.7%) and the inferior midline of the infratentorial(17.9%). 2) The middle fossa arachnoid cysts were prominent in males under the age of 20. 3) The common complicating lesions in the supratentorial arachnoid cysts were chronic subdural hematoma(23.5%) and subdural hygroma(5.9%). Hydrocephalus was usually combined with the infratentorial arachnoid cyst(66.7%). 4) The most frequent symptom was headache(75%) with similar frequency in both supratentorial and infratentorial lesions. In the supratentorial cysts, headache was also complained with highest frequency even in cases without increased intracranial pressure(61.5%). The main clinical features of arachnoid cysts were headache, signs of increased intracranial pressure, other neurologic deficits and seizure in order of frequency. 5) Cranial deformities on the plain X-ray films were observed in 70.6% of middle fossa cysts. The brain CT scan provided a definite diagnostic information, while the cerebral angiography offered clues for differential diagnosis. 6) The authors selected the direct intracranial approach as a curative measure in most cases and the essential step in this procedure was thought to establish a communication between the cyst and the basal cistern or adjacent subarachnoid space. But in a few special cases such as deep-seated cysts or extensively large ones, a cystoperitoneal shunt was a more preferable procedure. The infratentorial cysts with hydrocephalus almost always required ventriculoperitoneal shunt in our cases. We considered it is very important to perform periodic follow-up brain CT scan to detect a recurrence of cyst or recollection of C.S.F., postoperative complications and persistent hydrocephalus.
Arachnoid ; Arachnoid Cysts* ; Brain ; Cerebral Angiography ; Congenital Abnormalities ; Cranial Fossa, Middle ; Diagnosis, Differential ; Headache ; Humans ; Hydrocephalus ; Intracranial Pressure ; Male ; Neurologic Manifestations ; Postoperative Complications ; Recurrence ; Seizures ; Subarachnoid Space ; Tomography, X-Ray Computed ; Ventriculoperitoneal Shunt ; X-Ray Film

Aicardi syndrome is a severe congenital disorder characterized by infantile spasms, chorioretinal lacunae, and agenesis or hypogenesis of the corpus callosum. A 6 month old female had developed abnormal eye movement and seizures of the complex partial type and myoclonic type. MRI pictures of the patient revealed the presence of genu associated with agenesis of the rest of corpus callosum. A funduscopic examination revealed bilateral small, solitary, pale areas with sharp borders, some of which had minimal surrounding pigmentation (chorioretinal lacunae), especially clustered around the disc, and they were more prominent on the left side. We report here on the unusual findings of a complex partial seizure, myoclonic seizure and the atypical EEG finding in addition to the well-known characteristic clinical and imaging findings of a patient with Aicardi syndrome.
Anticonvulsants/therapeutic use ; Arachnoid Cysts/*pathology ; Corpus Callosum/*abnormalities ; Electroencephalography ; Epilepsies, Myoclonic/drug therapy/*pathology ; Epilepsies, Partial/drug therapy/*pathology ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Retinal Diseases/*pathology ; Spasms, Infantile/drug therapy/*pathology ; Syndrome

Pituitary adenoma accounts for 10% to 20% of intracranial tumors. Surgical approach to pituitary adenoma had been performed via craniotomy until the early 20th century, but transsphenoidal approach has been accepted as a primary procedure since 1910. However, there are frequent complications in the nose including nasal mucosal laceration, nasal septal perforation, and external nose deformities. Furthermore, cerebrospinal fluid leakage, visual field loss or blindness rarely occur. When blindness occurs by postoperative hematoma compression, revision operation is usually required for bleeding control and hematoma removal under general anesthesia. However, optic nerve decompression with postoperative hematoma removal via transsphenoidal approach can be adequately performed by endoscopic technique under local anesthesia, because there is no sensory nerve innervation in the pia mater and arachnoid membrane. We report a case of successful hematoma removal with bleeding control by endoscopic technique under local anesthesia in a patient who became blind due to postoperative hematoma after transphenoid approach for pituitary adenoma removal.
Anesthesia, General ; Anesthesia, Local* ; Arachnoid ; Blindness* ; Cerebrospinal Fluid ; Congenital Abnormalities ; Craniotomy ; Decompression ; Hematoma ; Hemorrhage ; Humans ; Lacerations ; Membranes ; Nasal Septal Perforation ; Nose ; Optic Nerve ; Pia Mater ; Pituitary Diseases ; Pituitary Neoplasms* ; Visual Fields