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February 4, 2008
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Teaching NeuroImage: Prepontine-suprasellar arachnoid cyst presenting with signs of normal pressure hydrocephalus

A 64-year-old man was referred to us for suspected normal pressure hydrocephalus (NPH), according to the clinical history of gait disturbance and urge incontinence, and radiologic evidence of a supratentorial hydrocephalus, with enlarged pericephalic spaces (figure 1). A new MRI revealed a 4-cm prepontine arachnoid cyst (figure 2). An endoscopic ventriculo-cystostomy was performed with a prompt improvement of symptoms.
Figure 1 First MRI examination
The first MRI examination revealed the presence of supratentorial ventriculomegaly out of proportion to sulcal atrophy, rounded frontal horns, and transependymal CSF flow in the form of periventricular high signal on T2-weighted FLAIR images.
Figure 2 T2-weighted images
(A, B) Preoperative T2-weighted images revealing a space-occupying suprasellar prepontine arachnoid cyst (arrows), displacing superiorly the third ventricle floor, the pituitary stalk and the optic chiasm, and, posteriorly, the mammillary bodies. (C, D) Postoperative T2-weighted images demon-strating a more horizontal orientation of chiasm and third ventricle floor. The cyst has shrunk (arrows).
Eighty-five percent of prepontine arachnoid cysts occur in children; most of them present with acute/subacute signs of increased intracranial pressure. The possibility of diagnosing these lesions in adults has been reported; only two cases have been described in the elderly, none of whom had symptoms of NPH.1,2

ACKNOWLEDGMENT

The authors thank Daniele Petricca for help with illustrations.

Footnotes

Disclosure: The authors report no conflicts of interest.
Series editor: Mitchell S.V. Elkind MD, MS, Section Editor

REFERENCES

1.
Kandogan T, Olgun L, Gultekin G, Aydar L, Sezgin O. A suprasellar arachnoid cyst destructing sphenoid sinus: an unusual cause of headache in an elderly female. Swiss Med Wkly 2004;134:28–29.
2.
Thompson TP, Levy EI, Jho HD, Lunsford LD. Primum non nocere: multimodality management strategies when multiple mass lesions strike a single patient. Surg Neurol 2001;55:332–339.

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Published In

Neurology®
Volume 70Number 6February 5, 2008
Pages: e26
PubMed: 18250284

Publication History

Published online: February 4, 2008
Published in print: February 5, 2008

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Authors

Affiliations & Disclosures

P. De Bonis, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
F. Novegno, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
G. Tamburrini, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
C. Anile, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
A. Pompucci, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
A. Mangiola, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.

Notes

Address correspondence and reprint requests to Dr. Federica Novegno, Institute of Neurosurgery, Catholic University School of Medicine, l.go A. Gemelli, 8 00168 Rome, Italy [email protected].

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Cited By
  1. Prepontine arachnoid cyst presenting with headache and diplopia: A case report study, Surgical Neurology International, 8, 1, (289), (2017).https://doi.org/10.4103/sni.sni_247_17
    Crossref
  2. Technical Considerations to Prevent Postoperative Endocrine Dysfunction after the Fenestration of Suprasellar Arachnoid Cyst, Journal of Korean Neurosurgical Society, 49, 5, (262), (2011).https://doi.org/10.3340/jkns.2011.49.5.262
    Crossref
  3. The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts, Journal of Neurosurgery: Pediatrics, 7, 1, (64-72), (2011).https://doi.org/10.3171/2010.10.PEDS10356
    Crossref
  4. Guidelines for the Management of Obstructive Hydrocephalus From Suprasellar-Prepontine Arachnoid Cysts Using Endoscopic Third Ventriculocystocisternostomy, Surgical Innovation, 17, 3, (206-216), (2010).https://doi.org/10.1177/1553350610377212
    Crossref
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