Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Revi
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SURGERY
Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Review of the Literature Senne Broekx 1,2
&
Jan Vandevenne 1,3,4 & Frank Weyns 1,2,4
Accepted: 7 September 2020 # Springer Nature Switzerland AG 2020
Abstract Intracranial arachnoid cysts (IACs) are benign, slow-growing developmental anomalies. In 4–14% of cases, IACs are accompanied by seizures. Since most cysts do not cause any symptoms, many lesions remain clinically silent and are found incidentally. As these lesions are slow-growing, they can become symptomatic over time and may give rise to epileptic seizures. Since IAC localization and seizure focus do not always coincide, a unifying theory between IACs and epileptogenesis is still lacking. We present a case of a 49-year old man who presented himself as a result of a first tonic-clonic insult. No major risk factors nor antecedents in his medical history were present. MRI confirmed a voluminous cystic lesion at the transition of motor cortex and supplementary motor area. Due to the large volume (with risk of cyst rupture) and compatible clinical, radiographic, and electroencephalographic features, cyst fenestration through craniotomy was performed. Epileptic seizures were resolved completely after this procedure. IACs are not uncommon and are frequently encountered incidentally in patients who present with epilepsy. Some authors have been classifying this association as rather exceptional. However, we illustrated a case in which excellent surgical results were obtained in a patient with focal epilepsy in which both clinical and electroencephalographic features were compatible with arachnoid cyst localization. Therefore, in patients with no other identifiable causes for epilepsy, thorough evaluation should be performed and surgical intervention should be considered. We developed a flowchart in order to guide clinicians in the appropriate approach of these patients. Therefore, this summary could serve as a scaffold for future highquality studies concerning this topic. Keywords Intracranial arachnoid cyst . Epilepsy . Surgery . Cyst fenestration . Case report
Introduction Intracranial arachnoid cysts (IACs) are benign, intraarachnoidal developmental anomalies containing a substance resembling cerebrospinal fluid [2, 5, 6, 9, 12, 15, 17, 23–25]. In adults, they account for about 1.5–2.3% of all intracranial
This article is part of the Topical Collection on Surgery * Senne Broekx [email protected] 1
Ziekenhuis Oost-Limburg, Schiepse bos 6, 3600 Genk, Belgium
2
Department of Neurosurgery, 3600 Genk, Belgium
3
Department of Radiology, 3600 Genk, Belgium
4
Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
masses [1, 9, 17, 18, 24] and are most commonly encountered in the middle cranial fossa, in accordance with the Sylvian and choroidal fissure [2, 6, 17]. Most IACs are congenital, although underlying causal events have been described of which infection, trauma, increased intracranial pressure, an
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