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01-04-2016 | Case Report

Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region

Authors: Liyong Sun, Stephan Emich, Wenzhuo Fu, Zan Chen, Wu Hao, Feng Ling, Fengzeng Jian

Published in: Neurosurgical Review | Issue 2/2016

Abstract

A retrocerebellar arachnoid cyst causing syringomyelia is extremely rare without tonsillar herniation. The authors present a 44-year-old woman with symptoms of foramen magnum compression and syringomyelia. Magnetic resonance imaging demonstrated a large retrocerebellar arachnoid cyst with a large cervicothoracic syrinx but no signs of tonsillar herniation or hydrocephalus. The patient underwent a foramen magnum decompression with C1 laminectomy, microsurgical fenestration of the cyst, and duraplasty. After successful reconstruction of CSF flow, the patient experienced a relief of symptoms and a significant reduction of the syrinx. The intraoperative findings support the theory of a piston mechanism in the development of syringomyelia. Additional arachnoidal adhesions may also obstruct the CSF flow around the craniocervical junction. We recommend the surgical treatment should consist of an adequate decompression of the foramen magnum, wide microsurgical arachnoidal debridement, and duraplasty with autologous grafts sutured in a watertight way.

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Apok V, Constantini S, Roth J (2012) Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia. Childs Nerv Syst 28:653–656CrossRefPubMed

Arai H, Sato K (1991) Posterior fossa cysts: clinical, neuroradiological and surgical features. Childs Nerv Syst 7:156–164CrossRefPubMed

Arunkumar MJ, Korah I, Chandy MJ (1998) Dynamic CSF flow study in the pathophysiology of syringomyelia associated with arachnoid cysts of the posterior fossa. Br J Neurosurg 12:33–36CrossRefPubMed

Banna M (1988) Syringomyelia in association with posterior fossa cysts. AJNR Am J Neuroradiol 9:867–873PubMed

Bauer AM, Mueller DM, Oro JJ (2005) Arachnoid cyst resulting in tonsillar herniation and syringomyelia in a patient with achondroplasia. Case report. Neurosurg Focus 19, E14CrossRefPubMed

Conti C, Lunardi P, Bozzao A, Liccardo G, Fraioli B (2003) Syringomyelia associated with hydrocephalus and Blake’s pouch cyst: case report. Spine (Phila Pa 1976) 28:E279–E283

Duddy JC, Allcutt D, Crimmins D, O’Brien D, O’Brien DF, Rawluk D, Sattar MT, Young S, Caird J (2014) Foramen magnum decompression for Chiari I malformation: a procedure not to be underestimated. Br J Neurosurg 28:330–334CrossRefPubMed

Ellenbogen RG, Armonda RA, Shaw DW, Winn HR (2000) Toward a rational treatment of Chiari I malformation and syringomyelia. Neurosurg Focus 8, E6CrossRefPubMed

Filippi R, Schwarz M, Voth D, Reisch R, Grunert P, Perneczky A (2001) Bovine pericardium for duraplasty: clinical results in 32 patients. Neurosurg Rev 24:103–107CrossRefPubMed

10.

Galarza M, Lopez-Guerrero AL, Martinez-Lage JF (2010) Posterior fossa arachnoid cysts and cerebellar tonsillar descent: short review. Neurosurg Rev 33:305–314, discussion 314CrossRefPubMed

11.

Gardner WJ, Angel J (1958) The mechanism of syringomyelia and its surgical correction. Clin Neurosurg 6:131–140PubMed

12.

Heiss JD, Snyder K, Peterson MM, Patronas NJ, Butman JA, Smith RK, Devroom HL, Sansur CA, Eskioglu E, Kammerer WA, Oldfield EH (2012) Pathophysiology of primary spinal syringomyelia. J Neurosurg Spine 17:367–380CrossRefPubMedPubMedCentral

13.

Hirano T, Kawamura T, Itoh J, Kanayama S (1999) A rare case of trapped fourth ventricle: an unique symptom appeared after fourth ventriculo-peritoneal shunting. No To Shinkei 51:247–251PubMed

14.

Huang H, Li Y, Xu K, Qu L, Yu J (2011) Foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia: case report and literature review. Int J Med Sci 8:345–350CrossRefPubMedPubMedCentral

15.

Jain R, Sawlani V, Phadke R, Kumar R (2000) Retrocerebellar arachnoid cyst with syringomyelia: a case report. Neurol India 48:81–83PubMed

16.

Joshi VP, Valsangkar A, Nivargi S, Vora N, Dekhne A, Agrawal A (2013) Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia. J Craniovertebr Junction Spine 4:43–45CrossRefPubMedPubMedCentral

17.

Kiran NA, Kasliwal MK, Suri A, Mahapatra AK (2010) Giant posterior fossa arachnoid cyst associated with syringomyelia. Clin Neurol Neurosurg 112:454–455CrossRefPubMed

18.

Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX (2004) Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure: a clinical review of 1 year. Neurosurgery 54:599–603, discussion 603–594CrossRefPubMed

19.

Marin SA, Skinner CR, Da Silva VF (2010) Posterior fossa arachnoid cyst associated with Chiari I and syringomyelia. Can J Neurol Sci 37:273–275CrossRefPubMed

20.

Martinez-Lage JF, Ruiz-Espejo A, Guillen-Navarro E, Almagro MJ (2008) Posterior fossa arachnoid cyst, tonsillar herniation, and syringomyelia in trichorhinophalangeal syndrome Type I. J Neurosurg 109:746–750CrossRefPubMed

21.

Milhorat TH (2000) Classification of syringomyelia. Neurosurg Focus 8, E1CrossRefPubMed

22.

Nomura S, Akimura T, Imoto H, Nishizaki T, Suzuki M (2002) Endoscopic fenestration of posterior fossa arachnoid cyst for the treatment of presyrinx myelopathy--case report. Neurol Med Chir (Tokyo) 42:452–454CrossRef

23.

Oldfield EH, Muraszko K, Shawker TH, Patronas NJ (1994) Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 80:3–15CrossRefPubMed

24.

Pang D, Zwienenberg-Lee M, Smith M, Zovickian J (2005) Progressive cranial nerve palsy following shunt placement in an isolated fourth ventricle: case report. J Neurosurg 102:326–331PubMed

25.

Shinoda S, Tanaka K, Kawaguchi K (1998) A huge retrocerebellar arachnoid cyst with syringomyelia: case report. No Shinkei Geka 26:363–367PubMed

26.

Siccardi D, Ventimiglia A (1995) Fibrotic-haemorrhagic reaction to synthetic dural substitute. Acta Neurochir (Wien) 132:148–149CrossRef

27.

Thakar S, Dadlani R, Tawari M, Hegde AS (2013) Atypical cerebellar slump syndrome and external hydrocephalus following craniocervical decompression for Chiari I malformation: case report. Neurol Med Chir (Tokyo)

28.

Thompson D, Taylor W, Hayward R (1994) Haemorrhage associated with silastic dural substitute. J Neurol Neurosurg Psychiatry 57:646–648CrossRefPubMedPubMedCentral

29.

Tokime T, Okamoto S, Yamagata S, Konishi T (1997) Syringomyelia associated with a posterior fossa cyst. Illustration of two cases. J Neurosurg 86:907CrossRefPubMed

Title: Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region
Authors: Liyong Sun
Stephan Emich
Wenzhuo Fu
Zan Chen
Wu Hao
Feng Ling
Fengzeng Jian
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 2/2016
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-015-0680-9

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Springer Medicine

Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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