Advertisement

Child's Nervous System

, Volume 22, Issue 9, pp 1091–1097 | Cite as

Functional assessment of intracranial arachnoid cysts with TC99 m-HMPAO SPECT: a preliminary report

  • Juan F. Martínez-LageEmail author
  • José A. Valentí
  • Claudio Piqueras
  • Antonio M. Ruiz-Espejo
  • Francisco Román
  • Juan A. Nuño de la Rosa
Original Paper

Abstract

Background

Many arachnoid cysts (AC) are detected incidentally in asymptomatic patients. Current neuroimaging methods provide only morphological details of the cysts, but they do not give information about cerebral function. While surgery is indicated in symptomatic patients, the management of asymptomatic individuals, who present with large cysts, is controversial.

Study objective

To ascertain the value of cerebral 99 mTc-HMPAO single photon emission computed tomography (SPECT) for detecting brain dysfunction in cases of intracranial ACs, aimed at allocating the patients for surgical or for conservative treatment.

Patients and methods

We studied prospectively 11 patients diagnosed with sylvian fissure ACs. The subjects underwent neurological examination, EEG, neuroimaging studies, neuropsychological testing, and cerebral perfusion studies with 99 mTc-HMPAO SPECT.

Results

The patients’ ages ranged from 2 to 42 years (median 16 years). The study group consisted of ten symptomatic patients with ACs and one patient with an incidental cyst. Seven patients showed diminished regional cerebral blood flow (rCBF) in their initial cerebral SPECT. Four individuals underwent surgery. Seven patients showed normalization of rCBF after surgical or conservative treatment.

Conclusions

Cerebral SPECT demonstrated impaired brain perfusion in 70% of symptomatic patients. The zone of decreased rCBF corresponded well with clinical symptoms and with neuroimaging findings. Patients exhibiting normal rCBF in SPECT studies remained or became asymptomatic during the follow-up time. Cerebral SPECT constitutes a valuable adjunct tool for correlating regional function with brain anatomy, and may be of help to allocate patients with ACs for surgical treatment or clinical observation. Further research on this field is warranted.

Keywords

Arachnoid cysts Cerebral SPECT Intracranial cysts Regional cerebral blood flow Cerebral perfusion 

Notes

Acknowledgement

The authors wish to show their appreciation to Mr. Saturnino Espín, of the Hospital’s Unit of Photography, for his collaboration in the production of the illustrations.

References

  1. 1.
    García Santos JM, Martínez-Lage JF, Gilabert Ubeda A, Capel Alemán A, Climent Oltrá V (1993) Arachnoid cysts of the middle cranial fossa: a consideration of their origin based on imaging. Neuroradiology 35:355–358CrossRefPubMedGoogle Scholar
  2. 2.
    Germano A, Caruso G, Caffo M, Baldari S, Calisto A, Meli F, Tomasello F (2003) The treatment of large supratentorial arachnoid cysts in infants with cyst-peritoneal shunting and Hakim programmable valve. Childs Nerv Syst 19:166–173PubMedGoogle Scholar
  3. 3.
    Henkes H, Huber G, Hierholzer J, Cordes M, Kujat C, Piepgras U (1991) Radionuklidzisternographie: SPECT und 3D-Technik. Radiologe 31:489–495PubMedGoogle Scholar
  4. 4.
    Holman BL, Zimmerman RE, Johnson KA, Carvalho PA, Schwartz RB, Loeffler JS, Alexander E, Pelizzari CA, Chen GT (1991) Computer-assisted superimposition of magnetic resonance and high-resolution technetium-99 m-HMPAO and thallium-201 SPECT images of the brain. J Nucl Med 32:1478–1484PubMedGoogle Scholar
  5. 5.
    Horiguchi T, Takeshita K (2000) Cognitive function and language of a child with an arachnoid cyst in the left frontal fossa. World J Biol Psychiatry 1:159–163PubMedCrossRefGoogle Scholar
  6. 6.
    Kidooka M, Okada T, Handa J (1992) Agenesis of the internal carotid artery-report of a case combined with arachnoid cyst in a child. No To Shinkei 44:371–375 (Japanese)PubMedGoogle Scholar
  7. 7.
    Kuwert T, Stodieck SR, Puskas C, Diehl B, Puskas Z, Schuierer G, Vollet B, Schober O (1996) Reduced GABAA receptor density contralateral to a potentially epileptogenic MRI abnormality in a patient with complex partial seizures. Eur J Nucl Med 23:95–98CrossRefPubMedGoogle Scholar
  8. 8.
    Martínez-Lage JF (1996) Neurosurgical treatment for hydrocephalus, subdural hematomas, and arachnoid cysts in glutaric aciduria type 1. Neuropediatrics 27:335–336PubMedCrossRefGoogle Scholar
  9. 9.
    Martinez-Lage JF, Ruiz-Macia D, Valentí JA, Poza M (1999) Development of a middle fossa arachnoid cyst. A theory on its pathogenesis. Childs Nerv Syst 15:94–97CrossRefPubMedGoogle Scholar
  10. 10.
    Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European cooperative study. Childs Nerv Syst 8:281–286CrossRefPubMedGoogle Scholar
  11. 11.
    Raimondi J, Choux M, Di Rocco C (1993) Intracranial cyst lesions. Springer, Berlin Heidelberg New YorkGoogle Scholar
  12. 12.
    Sato H, Sato N, Katayama S, Tamaki N, Matsumoto S (1991) Effective shunt-independent treatment for primary middle fossa arachnoid cyst. Childs Nerv Syst 7:375–381CrossRefPubMedGoogle Scholar
  13. 13.
    Sgouros S, Chapman S (2001) Congenital middle fossa arachnoid cysts may cause global brain ischaemia: a study with 99Tc hexamethylpropyleneamine- oxime single photon emission computerised tomography scans. Pediatr Neurosurg 35:188–194CrossRefPubMedGoogle Scholar
  14. 14.
    Tsurushima H, Harakuni T, Saito A, Tominaga D, Hyodo A, Yoshii Y (2000) Symptomatic arachnoid cyst of the left frontal convexity presenting with memory disturbance. Case report. Neurol Med Chir (Tokyo) 40:339–341CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Juan F. Martínez-Lage
    • 1
    • 4
    Email author
  • José A. Valentí
    • 2
  • Claudio Piqueras
    • 1
  • Antonio M. Ruiz-Espejo
    • 1
  • Francisco Román
    • 3
  • Juan A. Nuño de la Rosa
    • 2
  1. 1.Regional Service of NeurosurgeryVirgen de la Arrixaca University HospitalMurciaSpain
  2. 2.Service of Nuclear MedicineVirgen de la Arrixaca University HospitalMurciaSpain
  3. 3.Unit of NeuropsychologyFaculty of Psychology of the University of MurciaMurciaSpain
  4. 4.Laboratorio de Neurología y Neurocirugía Experimental (NYNE), Grupo OmegaUniversity of Murcia School of MedicineMurciaSpain

Personalised recommendations