1/8. Successful management of sellar and suprasellar arachnoid cysts with stereotactic intracavitary irradiation: an expanded report of four cases.OBJECTIVE: Sellar and suprasellar arachnoid cysts may be asymptomatic or may cause headache, optic nerve compression, endocrine dysfunction, or hydrocephalus. We propose a minimally invasive treatment strategy when intervention is indicated. methods: Four patients with sellar and suprasellar arachnoid cysts presented with headache, visual compromise, and endocrine dysfunction. Two of the four patients previously had undergone unsuccessful surgical intervention. The imaging studies of two patients were diagnostic of an arachnoid cyst. RESULTS: All four patients underwent stereotactic intracavitary radiation with cyst regression and symptomatic improvement. In each patient, the optic chiasm was decompressed successfully. There were no complications from the procedure. CONCLUSION: Stereotactic intracavitary irradiation of arachnoid cysts proved to be safe and effective. The procedure obviated the need for open cyst fenestration or shunting.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/8. Ockham's glaucoma.The combination of characteristic optic nerve head cupping, arcuate visual field loss and ocular hypertension would usually be thought sufficient to diagnose glaucoma. Only in the absence of elevated intraocular pressure, when normal tension glaucoma may be suspected, would intracranial imaging normally be performed to exclude occult pathology. A case is presented which illustrates the continuing need for vigilance, and an open mind, years after an apparently straight-forward diagnosis has been made.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/8. Endodermal cyst of the oculomotor nerve.Endodermal cysts are rare congenital intracranial lesions. Although histologically benign, they can become symptomatic as a result of mass effect and cause neurological deficits. We report a 30-year-old woman who presented with paresis of her right oculomotor nerve. magnetic resonance imaging showed a 13 x 8-mm cystic lesion originating from the right oculomotor nerve at its exit from the mesencephalon. She underwent craniotomy, biopsy, slit resection, and drainage of the cyst. To our knowledge, endodermal cysts have not been previously described in relation to the oculomotor nerve.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
4/8. Transient isolated trochlear nerve palsy associated with Rathke's cleft cyst.We report the case of a 52-year-old woman who developed vertical diplopia of 1-days duration. Neuro-ophthalmological testing revealed left trochlear nerve palsy, and sellar MRI revealed a 1.5 cm-sized pituitary mass lesion, a Rathke's cleft cyst. The diplopia disappeared spontaneously after 6 days.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
5/8. Giant supratentorial enterogenous cyst: report of a case, literature review, and discussion of pathogenesis.OBJECTIVE AND IMPORTANCE: To describe a histologically well-documented adult case of a giant supratentorial enterogenous cyst (EC). Fewer than 15 cases of supratentorial ECs are on record: 8 associated with the brain hemispheres or the overlying meninges, 4 with the sellar region, and 2 with the optic nerve. CLINICAL PRESENTATION: A 31-year-old woman complained of long-standing mild left brachial and crural motor deficit precipitated by headache and signs of intracranial hypertension. magnetic resonance imaging revealed a huge cyst overlying the frontoparietal brain. INTERVENTION: Symptoms were relieved by evacuation of the cyst content by means of a Rickam's reservoir, and the lesion was subsequently removed in toto. Histological and immunohistochemical examination of the cyst wall clearly established the enterogenous nature of its epithelium. Follow-up for up to 2 years after intervention showed no sign of recurrence, and symptoms, including treatment-resistant seizures in the postoperative period, have entirely subsided. CONCLUSION: Supratentorial ECs, distinctly rare in adult patients, may in some cases present as giant lesions. Total removal seems to be curative once careful examination has eliminated the possibility of a metastasis from an unknown primary. A correct histological diagnosis is important because, in contrast to other benign cysts of similar location and size, ECs may be prone to intraoperative dissemination.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/8. Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst. Case report.Rathke cleft cysts are commonly found on autopsy but are seldom symptomatic. Conventional treatment of these lesions consists of transsphenoidal drainage with partial excision of the cyst, and recurrence is rare. Alternatively, the instillation of absolute alcohol into the cyst has been described in several reports, with no complications. The authors report on a woman with Rathke cleft cyst that recurred three times after the initial treatment; the lesion was treated with alcohol cauterization on the final recurrence with devastating complications. This 51-year-old woman presented in 1992 with headaches and visual disturbances. Admission magnetic resonance imaging revealed a sellar/suprasellar lesion that was treated with conventional surgery and was subsequently confirmed to be a Rathke cleft cyst. The patient again presented with recurrence of the cyst at 22, 26, and 31 months after the initial presentation. On the final recurrence the cyst was treated with alcohol cauterization. Postoperatively, the patient awoke blind and suffered a seizure from leakage of the alcohol. The patient remains completely blind in both eyes and is also anosmic and has left lid ptosis and exotropia, which signify damage to the first through third cranial nerves. Rathke cleft cysts have been known to recur after primary surgery; however, this is the first report of a single cyst recurring three times despite conventional surgical treatment. Additionally, this is the first report in which devastating complications from alcohol cauterization of the cyst have been described. The authors therefore advocate caution when attempting alcohol cauterization and advise that meticulous care be taken to ensure the patency of the cyst.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/8. Isolated anisocoria from an endodermal cyst of the third cranial nerve mimicking an Adie's tonic pupil.We present only the second reported case in the literature of a neuroenteric cyst involving the third cranial nerve. Our case is highlighted by the initial presentation of an isolated anisocoria, initially believed to represent an Adie's tonic pupil as interpreted by pharmacologic testing. False-positive results may occur with the dilute pilocarpine test.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
8/8. Giant sacral meningeal diverticula: surgical implications of the "thecal tip" sign. Report of two cases.The surgical anatomy of giant sacral meningeal diverticula varies greatly depending on whether they develop ventral or dorsal to the thecal sac and spinal nerve roots. The ability to distinguish between the two lesion types preoperatively is therefore advantageous. The authors present a method of distinguishing ventral from dorsal meningeal diverticula on magnetic resonance imaging using the "thecal tip sign." They also describe the differences in operative technique required for resection of each type of diverticular cyst.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |