- Department of Neurosurgery, Main Military Hospital named after N.N. Burdenko, Moscow, Russia.
Artem Stanishevskiy, Department of Neurosurgery, Main Military Hospital named after N.N. Burdenko, Moscow, Russia.
DOI:10.25259/SNI_617_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Artem Stanishevskiy, Shamil Gizatullin, Denis Davydov. Giant arachnoid cyst in adult presented with secondary epileptiform activity. 24-Aug-2021;12:418
How to cite this URL: Artem Stanishevskiy, Shamil Gizatullin, Denis Davydov. Giant arachnoid cyst in adult presented with secondary epileptiform activity. 24-Aug-2021;12:418. Available from: https://surgicalneurologyint.com/surgicalint-articles/11067/
Background: Current studies contain controversies regarding indications and preferable surgical techniques for arachnoid cysts.
Case Description: In this paper we present case report of giant arachnoid cyst of right frontal lobe in young left-handed adult with headache, MRI sings of brain compression and epileptiform activity on EEG, treated by microsurgical cystostomy.
Conclusion: We add a case of young adult with tension headaches and possible sub-clinical seizures due to arachnoid cyst, whose symptoms disappeared after surgical management of the cyst, including normalization of EEG.
Keywords: Adult, Arachnoid cyst, Cystostomy, Epilepsy, frontal lobe
Arachnoid cysts (ACs) are common benign congenital intracranial lesions, most of them are an accidental finding.[
A Left handed adult patient with head deformity and everyday intensive headaches in the right temporal region, worsening with straining, presented in our neurosurgical department. Magnetic resonance imaging (MRI) scans showed giant arachnoid cyst of the right hemisphere [
No cognitive impairment was found: Mini Mental State Examination scale 30/30, Frontal Assessment Battery 18/18, Montreal Cognitive Assessment scale 30/30, Trial Making Test (TMT) A 27 s, TMT B 69 s, and Hamilton depression rating scale 5. Neurological examination showed no focal deficit. Ophthalmological examination reviled no signs of increased intracranial pressure (ICP). EEG detected epileptiform activity from the right frontal lobe [
Taking into account headaches, abnormal EEG, MRI signs of brain compression, and isolated type of cyst, we performed microsurgical cystostomy [
Postoperative course was fine, headaches disappeared, EEG showed resolution of epileptiform activity [
The common prevalence of ACs in adults is estimated at 1.4% and slightly higher in men then in women.[
Four main theories of cyst’s enlargement are as follows: (1) CSF secretion by inner surface of the cyst, (2) osmotic gradient between the cystic content and the CSF, (3) slit-valve mechanism between cyst and the subarachnoid space, and (4) pulsation of intracystic fluid of venous or arterial origin.[
Presented case characterized by unspecific symptoms, so treatment has been controversial. Despite the benefits from surgery of symptomatic arachnoid cysts, some authors proposed that seizures and headaches often persist after treatment.[
Surgical modalities available for ACs are as follows: microsurgical resection of cyst’s wall with or without connection with ventricles or basal cisterns; endoscopic fenestration; and cyst-peritoneal shunting. Several studies propose independence of clinical outcome from surgical modality.[
Yamasaki et al. noted that epileptic seizures may remain unchanged or worsen after surgery on interhemispheric ACs.[
ACs are rare reasons of headaches and seizures in adults. Surgery could be preferable treatment option despite minimal clinical presentation. Indications for surgery are as follows: increased ICP, evidences of cyst’s enlargement, hydrocephalus, signs of brain compression, and epileptiform activity. CT cisternography is useful for establishing indications for surgery while isolated cyst confirmed.
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