Arachnoid cysts | Radiology Case

Arachnoid cysts | Radiology Case

13 year-old-male with chronic headache.

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Observation and interpretation

  • Large extra-axial CSF intensity cystic lesions are seen along the right fronto-parieto-temporal convexity and left anterior temporal region (middle cranial fossa).
  • They follow CSF intensity on all sequences:
    • Hypointense on T1WI and hyperintense on T2WI.
    • They show suppression on FLAIR sequence.
    • No restricted diffusion.
  • Mass effect on underlying neuroparenchyma.

Principal Diagnosis

Arachnoid cysts (Galassi type III on right and Galassi type II on left)

Differential Diagnosis

  • Epidermoid cyst
    • incomplete suppression on FLAIR
    • restricted diffusion
    • lobulated appearance
  • Non-neoplastic cysts like Neurenteric cyst, porencephalic cyst
  • Cystic tumors like Pilocytic astrocytoma

Further Management

  • Neurosurgical referral
  • Because of the benign nature of MCFACs, treatment is not necessary in most cases.
  • However, in large symptomatic cysts, surgical intervention may be considered, such as cyst fenestration or cystoperitoneal shunting.

Teaching Points

Middle cranial fossa arachnoid cysts are classified by the Galassi classification:

  • Type I: small in size, occupying anterior temporal region (anterior middle cranial fossa) with no mass effect.
  • Type II: occupying anterior and middle temporal region with displacement of temporal lobe.
  • Type III: large in size with significant mass effect, filling the entire temporal fossa and extending into the fronto-parietal regions.

 

Other common locations for Arachnoid cysts include:

  • suprasellar cistern
  • quadrigeminal cistern
  • cerebellopontine angle
  • posterior fossa
  • spinal

Arachnoid cysts may be associated with Aicardi syndrome and Pallister-Hall syndrome.

Cite this article as:

Awal, S. S. (2023). Arachnoid cysts | Radiology Case. Radiology Vibes. Retrieved from https://radiologyvibes.com/case-details/1103

References

  1. Anne G. Osborn, Gary L. Hedlund, Karen L. Salzman. Osborn’s Brain. (2017)
  2. Gaillard F, Botz B, Rasuli B, et al. Arachnoid cyst. Reference article, Radiopaedia.org (Accessed on 22 Jan 2023) https://doi.org/10.53347/rID-929
  3. Mustansir F, Bashir S, Darbar A. Management of Arachnoid Cysts: A Comprehensive Review. Cureus. 2018 Apr 10;10(4):e2458. doi: 10.7759/cureus.2458. PMID: 29888162; PMCID: PMC5991924.
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