To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched using the keywords ‘endoscopy,’‘endoscopic,’ and ‘neuroendoscopic.’ Of these articles, those describing intraventricular lesions were reviewed. Suprasellar arachnoid cysts (SACs) can be treated with ventriculo-cystostomy (VC) or ventriculo-cysto-cisternostomy (VCC). VCC showed better results compared to VC. Procedure type, fenestration size, stent placement, and aqueductal patency may affect SAC prognosis. Colloid cysts can be managed using a transforaminal approach (TA) or a transforaminal-transchoroidal approach (TTA). However, TTA may result in better exposure compared to TA. Intraventricular cysticercosis can be cured with an endoscopic procedure alone, but if pericystic inflammation and/or ependymal reaction are seen, third ventriculostomy may be recommended. Tumor biopsies have yielded successful diagnosis rates of up to 100%, but tumor location, total specimen size, endoscope type, and vigorous coagulation on the tumor surface may affect diagnostic accuracy. An ideal indication for tumor excision is a small tumor with friable consistency and little vascularity. Tumor size, composition, and vascularity may influence a complete resection. SACs and intraventricular cysticercosis can be treated successfully using endoscopic procedures. Endoscopic procedures may represent an alternative to surgical options for colloid cyst removal. Solid tumors can be safely biopsied using endoscopic techniques, but endoscopy for tumor resection still results in considerable challenges.
Arachnoid Cysts ; Biopsy ; Colloid Cysts ; Cysticercosis ; Diagnosis ; Endoscopes ; Endoscopy ; Inflammation ; Prognosis ; Stents ; Ventriculostomy

Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.
Arachnoid Cysts/*diagnosis/pathology ; Brain/*pathology ; Brain Neoplasms/*diagnosis/pathology ; Contrast Media ; Humans ; Magnetic Resonance Imaging/*methods

Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.
Adult ; Arachnoid Cysts/*diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neurosurgical Procedures ; Oculomotor Nerve/*pathology ; Oculomotor Nerve Diseases/*diagnosis/surgery

We report here the case of a suprasellar cystic germ cell tumor (GCT) initially diagnosed as an arachnoid cyst. A 10-year-old boy experienced headache, dizziness, and diplopia, and was shown to have an approximately 2 cm suprasellar cyst. Two months after endoscopic third ventriculostomy was performed, a 5-6 cm cystic mass with an internal enhancing component was observed in the suprasellar cistern. Serum human chorionic gonadotropin levels were slightly increased in the serum and cerebrospinal fluid (55 and 162 IU/L, respectively) but were strikingly elevated in the cystic fluid (14,040 IU/L). The patient showed complete remission, with only a very small cystic lesion remaining after surgery, chemotherapy, and radiation treatment for a suprasellar mixed GCT. However, follow-up after treatment was complicated by moyamoya syndrome and cerebral infarction. GCT can be considered as a rare differential diagnosis in the case of a suprasellar cystic mass. Evaluation of tumor markers and close follow-up will be necessary.
Arachnoid* ; Central Nervous System Cysts* ; Cerebral Infarction ; Cerebrospinal Fluid ; Child ; Chorionic Gonadotropin ; Diagnosis, Differential ; Diplopia ; Dizziness ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Headache ; Humans ; Male ; Moyamoya Disease ; Neoplasms, Germ Cell and Embryonal* ; Biomarkers, Tumor ; Ventriculostomy

Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms.
Arachnoid ; Diagnosis, Differential ; Low Back Pain ; Magnetic Resonance Imaging ; Membranes ; Radiculopathy ; Steroids ; Tarlov Cysts

Adult ; Arachnoid Cysts ; complications ; diagnosis ; diagnostic imaging ; Headache ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography

OBJECTIVE: To explore the pathogenetic mechanism of cystic meningioma and the key to its diagnosis and operation. METHODS: Clinical data of 8 patients with cystic meningioma were analyzed retrospectively. The occuring position and cure rate of cystic meningioma were compared with those of solid meningioma in the corresponding period. RESULTS: All patients were subjected to total resection of tumor parenchyma and cystic wall. No operative death and severe complications occurred. The incidence of uppertentorial region of cystic meningioma was higher than that of solid meningioma, and the difference was significant (χ(2)=2.618, P<0.05). The cure rate was not significantly different between cystic meningioma and solid meningioma (χ(2)=0.010, P>0.05). CONCLUSION Removing tumor totally is the key to preventing its recurrence.
Adult ; Aged ; Arachnoid Cysts ; complications ; diagnosis ; surgery ; Female ; Humans ; Male ; Meningeal Neoplasms ; diagnosis ; surgery ; Meningioma ; classification ; complications ; diagnosis ; surgery ; Middle Aged ; Retrospective Studies

STUDY DESIGN: Retrospective study MR images for spinal cord tumors. PURPOSE: To analyze the characteristics of MR images for spinal cord tumors, which were then verified at surgery or biopsy. OVERVIEW OF LITERATURE: MR images are often used as the primary diagnostic imaging tool and the preoperative study of choice. The need for biopsy may be obviated because of increasingly accurate preoperative histologic diagnosis by MR images. METHODS: The study group consisted of 39 patients who had undergone MR imaging for preoperative evaluation of spinal cord tumors between September 1989 and February 2008. All patients had operations for spinal cord tumors, which were confirmed at biopsy. Of the 39 patients, 18 were men, and 21 were women. The average follow-up period was 23.8 months. The mean patient age was 46.6 years. RESULTS: Diagnoses included neurilemmoma (19 cases), neurofibroma (4 cases), meningioma (5 cases), hemangioma (3 cases), giant cell tumor (1 case), ganglioneuroma (1 case), lymphoma (1 case), neuroblastoma (1 case), and metastatic tumor from the prostate (1 case). The remaining 3 cases were composed of arachnoid cysts (2 cases) and a vascular malformation (arteriovenous malformation, 1 case). CONCLUSIONS: MR images are the preoperative modality of choice in the evaluation of spinal cord tumors. MR images can narrow the differential diagnosis and guide surgical resection.
Arachnoid Cysts ; Biopsy ; Diagnosis, Differential ; Diagnostic Imaging ; Female ; Follow-Up Studies ; Ganglioneuroma ; Giant Cell Tumors ; Hemangioma ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Meningioma ; Neurilemmoma ; Neuroblastoma ; Neurofibroma ; Prostate ; Retrospective Studies ; Spinal Cord ; Spinal Cord Neoplasms ; Vascular Malformations

Intracranial arachnoid cysts are collections of clear fluid within the arachnoid membrane because of nondisjunction or duplication of the structure. They are rare, represent only 1% of intracranial masses in newborns. Etiologically, they are thought to be due to maldevelopment of the arachnoid or secondary to trauma or infection. The arachnoid cyst by ultrasonogram shows characteristic well capsulated homogeneous hypoechoic cyst. Many arachnoid cysts remain asymptomatic, however, and become symptomatic later in life to cyst growth-resulting in a compression, displacement and irritation of the surrounding structures. So, early diagnosis and treatment of these cysts are important. We present two cases of arachnoid cysts diagnosed in utero by ultrasonogram. In one case, postnatal MRI was checked and confirmed arachnoid cyst with choroid plexus cyst. And other case, postnatal brain USG was checked and diagnosed arachnoid cyst. Both children are asymptomatic, and presents normal development until now. But latter children underwent surgical treatment due to persistent huge cyst and hydrocephalus.
Arachnoid Cysts ; Arachnoid* ; Brain ; Child ; Choroid Plexus ; Early Diagnosis ; Humans ; Hydrocephalus ; Infant, Newborn ; Magnetic Resonance Imaging ; Membranes ; Prenatal Diagnosis* ; Ultrasonography

OBJECTIVESTo reveal the relationship of brain motion and cerebrospinal fluid (CSF) flow by phase-contrast cine MRI, and to evaluate this technique in differentiating between arachnoid cysts and subarachnoid space enlargement.

METHODSUsing a phase-contrast cine MRI pulse sequence, we measured brain motion and CSF flow during the cardiac cycle in 10 healthy volunteers and 10 patients with MRI-suspected arachnoid cyst or subarachnoid space enlargement. CSF stroke volume curve was illustrated according to flow quantification, and time-signal intensity curve was traced. The two curves were compared.

RESULTSThis study showed that brain motion was due to the volume difference between arterial and venous blood flow during a cardiac cycle, and thus drives CSF pulsation. Arachnoid cysts and subarachnoid space enlargement carried different curve patterns, demonstrating that phase-contrast MRI and flow quantification can be a useful and reliable technique for non-invasive evaluation of brain motion and CSF flow.

CONCLUSIONArachnoid cysts can be successfully differentiated using phase-contrast cine MRI from subarachnoid space enlargement.

Adult ; Arachnoid Cysts ; diagnosis ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging, Cine ; Male ; Subarachnoid Space ; pathology