Child's Nervous System

, Volume 27, Issue 3, pp 429–438 | Cite as

Interpeduncular arachnoid cysts in infants and children: insight into the entity based on a case series with long-term follow-up

  • Dimitrios Paraskevopoulos
  • Jonathan Roth
  • Liana Beni-Adani
  • Shlomi Constantini
Original Paper
First Online:
Received:
Accepted:

Abstract

Objective

Arachnoid cysts occupying the suprasellar region comprise 10–15% of intracranial distribution. Unlike large suprasellar cysts, pure interpeduncular cysts (IPCs) are rare, and their natural history is unknown. We describe a small series of children diagnosed with IPC and their long-term natural history.

Methods

A retrospective review was conducted of interpeduncular arachnoid cysts diagnosed over the years 2000–2010 at our center. Patients with clearly suprasellar cysts were excluded. Serial magnetic resonance imaging and long-term follow-up examinations were analyzed. Additionally, we conducted an extensive literature review focusing on the differences between suprasellar cysts and IPCs.

Results

We identified three pediatric patients with “pure” IPC; all of these had a follow-up of more than 5 years, and none was operated. Only six additional cases were identified in the literature. In both our experience and in the literature review, IPCs proved stable over the course of time, both radiologically as well as clinically.

Conclusions

The clinical and radiological features of IPCs are not well defined. Variations in the relationship of arachnoid cysts in this area to Liliequist’s membrane may explain the different subgroups that have been identified as well as the confusing nomenclature. IPCs are usually diagnosed as incidental findings or present with mild endocrine disorders. Associated findings of hydrocephalus, mass effect, and compression of neighboring structures, such as the chiasm, are not as frequent as with suprasellar cysts. Given the high likelihood of continuing stability, a conservative strategy of follow-up is recommended for pure IPCs that demonstrate preservation of the third ventricle.

Keywords

Interpeduncular Suprasellar Prepontine Arachnoid cyst Natural history Hydrocephalus Hormones Chiasm 
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Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Akyuz M, Goksu E, Aralasmak A, Tuncer R (2010) Retroclival arachnoid cyst presenting with haemorrhage: a brief report of a special case. Acta Neurochir (Wien) 152:161–162CrossRefGoogle Scholar
  2. 2.
    Arai H, Sato K (1991) Posterior fossa cysts: clinical, neuroradiological and surgical features. Childs Nerv Syst 7:156–164CrossRefPubMedGoogle Scholar
  3. 3.
    Ashker L, Weinstein JM, Dias M, Kanev P, Nguyen D, Bonsall DJ (2008) Arachnoid cyst causing third cranial nerve palsy manifesting as isolated internal ophthalmoplegia and iris cholinergic supersensitivity. J Neuroophthalmol 28:192–197PubMedGoogle Scholar
  4. 4.
    Binitie O, Williams B, Case CP (1984) A suprasellar subarachnoid pouch; aetiological considerations. J Neurol Neurosurg Psychiatry 47:1066–1074CrossRefPubMedGoogle Scholar
  5. 5.
    Bonde V, Muzumdar D, Goel A (2008) Retroclival arachnoid cyst with hemifacial spasm. Singapore Med J 49:e281–e282PubMedGoogle Scholar
  6. 6.
    Bourekas EC, Raji MR, Dastur KJ, Francken GJ, Engle DJ, Nayak NT (1992) Retroclival arachnoid cyst. AJNR Am J Neuroradiol 13:353–354PubMedGoogle Scholar
  7. 7.
    Buxton N, Vloeberghs M, Punt J (1999) Flexible neuroendoscopic treatment of suprasellar arachnoid cysts. Br J Neurosurg 13:316–318CrossRefPubMedGoogle Scholar
  8. 8.
    Caemaert J, Abdullah J, Calliauw L, Carton D, Dhooge C, van Coster R (1992) Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 119:68–73CrossRefGoogle Scholar
  9. 9.
    Charalampaki P, Filippi R, Welschehold S, Conrad J (2005) Endoscopic and endoscope-assisted neurosurgical treatment of suprasellar arachnoidal cysts (Mickey Mouse cysts). Minim Invasive Neurosurg 48:283–288CrossRefPubMedGoogle Scholar
  10. 10.
    Crimmins DW, Pierre-Kahn A, Sainte-Rose C, Zerah M (2006) Treatment of suprasellar cysts and patient outcome. J Neurosurg 105:107–114PubMedGoogle Scholar
  11. 11.
    Decq P, Brugieres P, Le Guerinel C, Djindjian M, Keravel Y, Nguyen JP (1996) Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 84:696–701CrossRefPubMedGoogle Scholar
  12. 12.
    Di Rocco C, Caldarelli M, Ceddia A (1993) Incidence, anatomical distribution and classification of arachnoid cysts. In: Raimondi AJ, Choux M, Di Rocco C (eds) Intracranial cyst lesions. Springer, New York, pp 101–111Google Scholar
  13. 13.
    Dwarakanath S, Suri A, Mahapatra AK, Mehta VS, Gaikwad S, Sarkar C (2006) Endoscopic assisted excision of a retroclival arachnoid cyst presenting as hysterical breathlessness. Childs Nerv Syst 22:424–427CrossRefPubMedGoogle Scholar
  14. 14.
    Erdincler P, Kaynar MY, Bozkus H, Ciplak N (1999) Posterior fossa arachnoid cysts. Br J Neurosurg 13:10–17CrossRefPubMedGoogle Scholar
  15. 15.
    Ersahin Y, Kesikci H, Ruksen M, Aydin C, Mutluer S (2008) Endoscopic treatment of suprasellar arachnoid cysts. Childs Nerv Syst 24:1013–1020CrossRefPubMedGoogle Scholar
  16. 16.
    Fitzpatrick MO, Barlow P (2001) Endoscopic treatment of prepontine arachnoid cysts. Br J Neurosurg 15:234–238CrossRefPubMedGoogle Scholar
  17. 17.
    Fox JL, Al-Mefty O (1980) Suprasellar arachnoid cysts: an extension of the membrane of Liliequist. Neurosurgery 7:615–618CrossRefPubMedGoogle Scholar
  18. 18.
    Froelich SC, Abdel Aziz KM, Cohen PD, van Loveren HR, Keller JT (2008) Microsurgical and endoscopic anatomy of Liliequist's membrane: a complex and variable structure of the basal cisterns. Neurosurgery 63:ONS1-8, discussion ONS8-9CrossRefGoogle Scholar
  19. 19.
    Galassi E, Tognetti F, Frank F, Fagioli L, Nasi MT, Gaist G (1985) Infratentorial arachnoid cysts. J Neurosurg 63:210–217CrossRefPubMedGoogle Scholar
  20. 20.
    Gangemi M, Colella G, Magro F, Maiuri F (2007) Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 21:276–280CrossRefPubMedGoogle Scholar
  21. 21.
    Grollmus JM, Wilson CB, Newton TH (1976) Paramesencephalic arachnoid cysts. Neurology 26:128–134PubMedGoogle Scholar
  22. 22.
    GRt H, Edwards MS, Wilson CB (1986) Intracranial arachnoid cysts in children. J Neurosurg 64:835–842CrossRefGoogle Scholar
  23. 23.
    Hoffman HJ, Hendrick EB, Humphreys RP, Armstrong EA (1982) Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57:597–602CrossRefPubMedGoogle Scholar
  24. 24.
    Ikeda H, Deinsberger W, Boker DK (2000) Retroclival arachnoid cyst presenting with spontaneous intracystic haemorrhage—case presentation. Acta Neurochir (Wien) 142:1317–1318CrossRefGoogle Scholar
  25. 25.
    Kang JK, Lee KS, Lee IW, Jeun SS, Son BC, Jung CK, Park YS, Lee SW (2000) Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children. Childs Nerv Syst 16:111–116CrossRefPubMedGoogle Scholar
  26. 26.
    Kirollos RW, Javadpour M, May P, Mallucci C (2001) Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:713–718CrossRefPubMedGoogle Scholar
  27. 27.
    Lena G, Erdincler P, Van Calenberg F, Genitori L, Choux M (1996) Arachnoid cysts of the middle cranial fossa in children. A review of 75 cases, 47 of which have been operated in a comparative study between membranectomy with opening of cisterns and cystoperitoneal shunt. Neurochirurgie 42:29–34PubMedGoogle Scholar
  28. 28.
    Matsuno H, Rhoton AL Jr, Peace D (1988) Microsurgical anatomy of the posterior fossa cisterns. Neurosurgery 23:58–80CrossRefPubMedGoogle Scholar
  29. 29.
    Miyajima M, Arai H, Okuda O, Hishii M, Nakanishi H, Sato K (2000) Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases. J Neurosurg 93:62–67CrossRefPubMedGoogle Scholar
  30. 30.
    Nakamura Y, Mizukawa K, Yamamoto K, Nagashima T (2001) Endoscopic treatment for a huge neonatal prepontine-suprasellar arachnoid cyst: a case report. Pediatr Neurosurg 35:220–224CrossRefPubMedGoogle Scholar
  31. 31.
    Oberbauer RW, Haase J, Pucher R (1992) Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8:281–286CrossRefPubMedGoogle Scholar
  32. 32.
    Quint DJ (1992) Retroclival arachnoid cyst. AJNR Am J Neuroradiol 13:1503–1504PubMedGoogle Scholar
  33. 33.
    Raffel C, McComb JG (1988) To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients? Neurosurgery 23:338–342CrossRefPubMedGoogle Scholar
  34. 34.
    Raimondi AJ, Shimoji T, Gutierrez FA (1980) Suprasellar cysts: surgical treatment and results. Childs Brain 7:57–72PubMedGoogle Scholar
  35. 35.
    Rengachary SS, Watanabe I (1981) Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61–83PubMedGoogle Scholar
  36. 36.
    Robinson RG (1964) The temporal lobe agenesis syndrome. Brain 87:87–106CrossRefPubMedGoogle Scholar
  37. 37.
    Samii M, Carvalho GA, Schuhmann MU, Matthies C (1999) Arachnoid cysts of the posterior fossa. Surg Neurol 51:376–382CrossRefPubMedGoogle Scholar
  38. 38.
    Santamarta D, Aguas J, Ferrer E (1995) The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 38:133–137CrossRefPubMedGoogle Scholar
  39. 39.
    Schievink WI, Wijdicks EF (1997) Pretruncal subarachnoid hemorrhage: an anatomically correct description of the perimesencephalic subarachnoid hemorrhage. Stroke 28:2572PubMedGoogle Scholar
  40. 40.
    Schroeder HW, Gaab MR (1997) Endoscopic observation of a slit-valve mechanism in a suprasellar prepontine arachnoid cyst: case report. Neurosurgery 40:198–200CrossRefPubMedGoogle Scholar
  41. 41.
    Sood S, Schuhmann MU, Cakan N, Ham SD (2005) Endoscopic fenestration and coagulation shrinkage of suprasellar arachnoid cysts. Technical note. J Neurosurg 102:127–133PubMedGoogle Scholar
  42. 42.
    Struck AF, Murphy MJ, Iskandar BJ (2006) Spontaneous development of a de novo suprasellar arachnoid cyst. Case report. J Neurosurg 104:426–428CrossRefPubMedGoogle Scholar
  43. 43.
    Sufianov AA, Sufianova GZ, Iakimov IA (2009) Microsurgical study of the interpeduncular cistern and its communication with adjoining cisterns. Childs Nerv Syst 25:301–308CrossRefPubMedGoogle Scholar
  44. 44.
    Sweasey TA, Venes JL, Hood TW, Randall JB (1989) Stereotactic decompression of a prepontine arachnoid cyst with resolution of precocious puberty. Pediatr Neurosci 15:44–47CrossRefPubMedGoogle Scholar
  45. 45.
    Wang JC, Heier L, Souweidane MM (2004) Advances in the endoscopic management of suprasellar arachnoid cysts in children. J Neurosurg 100:418–426PubMedGoogle Scholar
  46. 46.
    Zhang M, An PC (2000) Liliequist's membrane is a fold of the arachnoid mater: study using sheet plastination and scanning electron microscopy. Neurosurgery 47:902–908, discussion 908–909CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Dimitrios Paraskevopoulos
    • 1
  • Jonathan Roth
    • 1
  • Liana Beni-Adani
    • 1
  • Shlomi Constantini
    • 1
  1. 1.Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical CenterTel Aviv UniversityTel AvivIsrael

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