Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1811  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (139 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed5255    
    Printed129    
    Emailed1    
    PDF Downloaded165    
    Comments [Add]    
    Cited by others 4    

Recommend this journal

 


 
CASE REPORT
Year : 2007  |  Volume : 55  |  Issue : 4  |  Page : 388-389

Teflon sponge shunt for recurrent arachnoid cyst


Department of Neurosurgery, King Edward Memorial Hospital, Seth G. S. Medical College, Parel, Mumbai - 400012, India

Date of Acceptance11-Jun-2007

Correspondence Address:
Atul Goel
Department of Neurosurgery, King Edward Memorial Hospital, Seth G. S. Medical College Parel, Mumbai - 400 012
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.37097

Rights and Permissions

 » Abstract 

A 50-year-old female presented with complaints of progressive ataxia. Investigations showed a large intradural arachnoid cyst located anterior to the brainstem. Following marsupialization of the cyst she improved remarkably in her symptoms. The symptoms recurred nine months later and investigations revealed recurrence of the cyst. The cyst was evacuated again and two Teflon sponge sheets were placed such that they traversed the length of the cyst cavity and extended into the cisterna magna. At follow-up after 25 months, there has been no recurrence of symptoms or the cyst. The role and advantages of Teflon sponge in such cases is evaluated.


Keywords: Arachnoid cyst, cyst-subarachnoid shunt, Teflon sponge


How to cite this article:
Goel A, Shah AH, Pareikh S. Teflon sponge shunt for recurrent arachnoid cyst. Neurol India 2007;55:388-9

How to cite this URL:
Goel A, Shah AH, Pareikh S. Teflon sponge shunt for recurrent arachnoid cyst. Neurol India [serial online] 2007 [cited 2019 Apr 19];55:388-9. Available from: http://www.neurologyindia.com/text.asp?2007/55/4/388/37097



 » Introduction Top


Symptomatic recurrence of arachnoid cyst after partial wall resection or marsupialization is a well-known phenomenon. A variety of shunt procedures have been advocated to prevent cyst recurrence. We report a case where the cyst was located anterior to the brainstem and a radical total resection of the cyst wall was not possible. Recurrence of the cyst was treated with a cyst to subarachnoid space Teflon sponge shunt. We believe that such a shunt could be a useful mode of treatment of arachnoid cysts.


 » Case Report Top


A 50-year-old- female presented with symptoms of headache and progressive ataxia. Neurological examination revealed mild papilledema and marked truncal ataxia. Magnetic resonance imaging (MRI) showed a large cyst located anterior to the brainstem and resulted in its significant posterior hump [Figure - 1]. A posterior midline approach was adopted. The cyst containing clear cerebrospinal fluid (CSF) was drained after exposing it from between the lower cranial nerves. The entire surgical field collapsed as soon as the cyst was evacuated. This made identification of the cyst wall difficult and its safe isolation from the adjoining arachnoid membrane, cranial nerves and blood vessels impossible. The patient had rapid improvement of symptoms following surgery and she returned to her normal lifestyle. She followed up nine months after surgery with complaints of recurrence of symptoms of progressive ataxia. Repeat MRI showed recurrence of the large arachnoid cyst. The lesion was again approached from the same exposure. After evacuation of the cyst, two 4 mm thick, 8 mm wide and 30 mm long Teflon sponge strips were placed that extended from the cyst cavity to the cisterna magna. The Teflon sheaths were anchored with a stitch to the dura and arachnoid in the region of the foramen magnum. The patient improved again after surgery and at follow-up after 25 months there has been no recurrence of symptoms. A track of CSF could be seen along the site of the Teflon sheath, probably suggesting functioning of the shunt [Figure - 2],[Figure - 3].


 » Discussion Top


Arachnoid cysts are relatively uncommon and represent approximately 1% of all benign intracranial lesions. [1] Posterior fossa arachnoid cysts are uncommon. Of these, arachnoid cysts ventral to the brainstem form a small subset? Rengachary et al. found only 3% of cysts to be located in the retroclival region. [2] Since cysts located anterior to the brainstem are uncommon in practice, experiences in their management are limited and the best method of treatment for them remains unclear.

The indications of surgery for arachnoid cyst remain controversial. Progression of neural compressive symptoms forms a definite indication for surgery. A number of authors have indicated that radical resection of the cyst that includes the entire wall is curative for these benign lesions. On the other hand, marsupialization of the cyst contents is a straightforward surgical procedure and recurrences even in such cases are infrequent. [3] A number of shunting procedures have also been used successfully. Numerous types and techniques of shunts have been described for arachnoid cysts. External shunts include diversion of cyst fluid to the peritoneum, pleura and atrium of the heart. [1],[4],[5],[6],[7] Internal shunts include cyst-subarachnoid shunt and cysto-subdural shunt. [1],[6],[7]

Although total resection of the wall of the arachnoid cyst is a recommended form of treatment, complete resection of the wall may be not possible in many such cases. In the reported case, the location of the cyst anterior to the brainstem made radical resection of the cyst wall difficult. Placement of a Teflon sponge that extended from the cyst to the cisterna magna was seen to be effective. The non-absorbable and non-reactive nature of Teflon is ideally suited for intracranial use. Such a material has been used widely for the treatment of microvascular decompression surgery. The multiple porosities in the Teflon sponge have obvious advantages over a single tube shunt that is more susceptible to blockages or kinking. Our successful experience in the presented case suggests that such a Teflon sponge internal cyst-subarachnoid shunt could constitute an effective primary form of treatment of arachnoid cysts.

 
 » References Top

1.Fitzpatrick MO, Barlow P. Endoscopic treatment of prepontine arachnoid cysts. Br J Neurosurg 2001;15:234-8.  Back to cited text no. 1  [PUBMED]  
2.Rengachary SS, Watanabe I. Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 1981;40:61-83.   Back to cited text no. 2  [PUBMED]  
3.Jones RF, Warnock TH, Nayanar V, Gupta JM. Suprasellar arachnoid cysts: Management by cyst wall resection. Neurosurgery 1989;25:554-61.  Back to cited text no. 3  [PUBMED]  
4.Oka Y, Kumon Y, Kohno M, Saitoh M, Sakaki S. Treatment of suprasellar arachnoid cyst-two case reports. Neurol Med Chir (Tokyo) 1996;36:721-4.  Back to cited text no. 4    
5.Buxton N, Vloeberghs M, Punt J. Flexible neuroendoscopic treatment of suprasellar arachnoid cysts. Br J Neurosurg 1999;13:316-8.  Back to cited text no. 5  [PUBMED]  
6.Decq P, Brugieres P, Le Guerinel C, Djindjian M, Keravel Y, Nguyen JP. Percutaneous endoscopic treatment of suprasellar arachnoid cysts: Ventriculocystostomy or ventriculocystocisternotomy? Technical note. J Neurosurg 1996;84:696-701.  Back to cited text no. 6    
7.D'Angelo V, Gorgoglione L, Catapano G. Treatment of symptomatic intracranial arachnoid cysts by stereotactic cyst - ventricular shunting. Stereotact Funct Neurosurg 1999;72:62-9.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Polytetraf luoroethylene sponge syringosubarachnoid shunt
Chagla, A.S. and Kansal, R. and Srikant, B.
Turkish Neurosurgery. 2011; 21(3): 443-445
[Pubmed]
2 Indigenous Customized Sponge Shunt for a Recurrent Brainstem Cyst
Aliasgar V. Moiyadi,Prakash M. Shetty
World Neurosurgery. 2010; 73(4): 417
[Pubmed] | [DOI]
3 Indigenous customized sponge shunt for a recurrent brainstem cyst
Moiyadi, A.V., Shetty, P.M.
World Neurosurgery. 2010; 73(4): 417-419
[Pubmed]
4 Endoscopic treatment of the suprasellar arachnoid cyst
Yadav, Y.R., Parihar, V., Sinha, M., Jain, N.
Neurology India. 2010; 58(2): 280-283
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow