Arachnoid cyst of the brain and epilepsy

The high prevalence of arachnoid cysts (AC) of the brain, often with epileptic seizures, and the uncertainty of their relationship.

PURPOSE: To analyze the experience of surgical treatment of children with AK and epileptic seizures using the method of determining craniospinal compliance.

MATERIALS AND METHODS: The study included 36 children with supratentorial AKs aged from 9 months to 17 years. Inclusion criteria: 1) patient age under 17 years; 2) the presence of supratentorial ACs according to MRI of the brain; 3) detection of at least 2 epileptic seizures in patients with AK for more than 24 hours; 4) verification of pharmacoresistance is not mandatory; 5) patients were taking antiepileptic drugs. AK with epilepsy without hypertensive syndrome and AK with a combination of hypertension and epileptic syndrome. During surgery, an infusion-load test was used in 10 patients to assess the biomechanical properties of the craniospinal system.

RESULTS. ACs of the lateral fissure of the brain were detected in 24 (66.7 %) patients, convexital ones — in 11 (30.5 %), interhemispheric fissure — 1 (2.8 %). In the first group, localized epileptic activity was found in 20 (76.9 %), unilateral multifocal — in 4, diffuse — in 2. The localization of AC in 22 (84.6 %) cases did not coincide with the location of the epileptic focus. In the second group, focal activity was detected in only one child, and the localization of the lesion and the AC did not coincide. In the first group, operations aimed at removing the epileptic focus, neuromodulation and disconnection were performed. In the second group — cystocisternostomy for the correction of hypertension syndrome. In the first group, the outcome was Engel I in 14 (53.8 %) patients, Engel II–IV in 12 (46.2 %). In the second group, the hypertension syndrome regressed in all observations, and the epileptic syndrome did not undergo significant changes.

CONCLUSION. AK manifested by hypertensive syndrome is an indication for cystocisternostomy, and the use of methods for assessing craniospinal compliance allows optimizing treatment tactics. Drug-resistant epilepsy with a localized epileptic focus requires its removal, regardless of the presence of AC.

1. Al-Holou W.N., Yew A. Y., Boomsaad Z. E., Garton H. J., Muraszko K. M., & Maher C. O. prevalence and natural history of arachnoid cysts in children. Journal of neurosurgery. Pediatrics. 2010;5(6), 578–585. https://doi.org/10.3171/2010.2.PEDS09464

2. Candela S., Puerta P., Alamar M., Barcik U., Guillén A., Muchart J., García-Fructuoso G., & Ferrer-Rodríguez E. (2015). Epidemiología y clasificación de los quistes aracnoideos en niños [Epidemiology and classification of arachnoid cysts in children]. Neurocirugia. 2015; 26(5), 234–240. https://doi.org/10.1016/j.neucir.2015.02.007

3. Hachatryan V.A., Samochernyh K.A. Endoskopiya v detskoj nejrohirurgii. Spb.: Branko, 2015. 276s. (In Russ.)

4. Hachatryan V.A., Samochernyh K.A., Sysoev K. V., Abramov K. B., Nikolaenko M. S. Optimizaciya hirurgicheskogo lecheniya arahnoidal’nyh kist konveksital’noj poverhnosti i sil’vievoj shcheli mozga u detej. Rossijskij nejrohirurgicheskij zhurnal im. A. L. Polenova. 2018;10b(1):67–73. (In Russ.)

5. del Brutto O. H., Mera R. M., Kiernan J., Castle P., Zambrano M., Sedler M. J. Supratentorial arachnoid cysts and seizures/epilepsy: A population study in community dwellers aged ≥20 years. Epilepsia. 2019;60(8):83–87. https://doi.org/10.1111/epi.16287

6. Mackle T., Wile, D. Arachnoid Cysts And Adult Onset Epilepsy. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne. 2017;189(7):280. https://doi.org/10.1503/cmaj.160423

7. Nikolić I., Ristić A., Vojvodić N., Baščarević V., Ilanković A., Berisavac I., Đukić T., & Sokić D. The association of arachnoid cysts and focal epilepsy: Hospital based case control study. Clinical neurology and neurosurgery. 2017;159:39–41. https://doi.org/10.1016/j.clineuro.2017.05.014

8. Ventura N., d’Andrea I., Cardoso M. F., Alves-Leon S.V., & Gasparetto E. L. Arachnoid cysts and absence epilepsy: an evidence or a coincidence?. Arquivos de neuro-psiquiatria. 2011;69(2A):262–263. https://doi.org/10.1590/s0004–282x2011000200024

9. Arroyo, S., & Santamaria, J. what is the relationship between arachnoid cysts and seizure foci?. Epilepsia. 1997;38(10):1098–1102. https://doi.org/10.1111/j.1528–1157.1997.tb01199.x

10. Murthy J. M. Intracranial arachnoid cysts: epileptic seizures. Neurology India. 2013;61(4):343–344. https://doi.org/10.4103/0028–3886.117580

11. Orduna Martínez J., López Pisón J., Curto Simón B., García-Iñiguez J. P., Samper Villagrasa P., Lafuente Hidalgo M. Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature. Neurocirugia (English Edition). 2022;33(4);157–164. https://doi.org/10.1016/j.neucie.2021.03.001

12. Yalçin A. D., Oncel C., Kaymaz A., Kuloğlu N., Forta, H. Evidence against association between arachnoid cysts and epilepsy. Epilepsy research. 2002;49(3);255–260. https://doi.org/10.1016/s0920–1211(02)00050-5

13. Koch C.A., Voth d., Kraemer G., Schwarz M. (1995). Arachnoid cysts: does surgery improve epileptic seizures and headaches? Neurosurgical review. 1995;18(3):173–181. https://doi.org/10.1007/BF00383722

14. Wang C., Liu C., Xiong Y., Han G., Yang H., Yin H., Wang J., You, C. Surgical treatment of intracranial arachnoid cyst in adult patients. Neurology India. 2013;61(1):60–64. https://doi.org/10.4103/0028–3886.108013

15. Engel J. Surgical treatment of the epilepsies. 2nd edition. Philadelphia: Lippincott Williams & Wilkins, 1993. p. 786.

16. Dangouloff-Ros V., Roux C. J., Boulouis G., Levy R., Nicolas N., Lozach C., Grevent d., Brunelle F., Boddaert N., Naggara O. Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis. AJNR. American journal of neuroradiology. 2019;40(11):1818–1823. https://doi.org/10.3174/ajnr.A6281

17. Hayes M. J., TerMaath S.C., Crook T. R., Killeffer, J.A. A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults. world neurosurgery. 2018;123:259–272. https://doi.org/10.1016/j.wneu.2018.11.149

18. Moss T., Helland C. A., Mørkve S. H., Wester, K. Surgical decompression of arachnoid cysts leads to improved quality of life: a prospective study-long-term follow-up. Acta neurochirurgica. 2019;161(11):2253–2263. https://doi.org/10.1007/s00701-019-03990-6

19. Rabiei, K., Högfeldt, M. J., Doria-Medina, R., & Tisell, M. (2016). Surgery for intracranial arachnoid cysts in children-a prospective long-term study. Child’s nervous system: ChNS: official journal of the International Society for pediatric Neurosurgery. 2016;32(7):1257–1263. https://doi.org/10.1007/s00381-016-3064-8

20. Zhang, B., Zhang, Y., & Ma, Z. (2012). Long-term results of cystoperitoneal shunt placement for the treatment of arachnoid cysts in children. Journal of neurosurgery. Pediatrics. 2012;10(4):302–305. https://doi.org/10.3171/2012.7.PEDS11540

21. Samochernyh K. A. personalizirovannaya diagnostika i nejrohirurgicheskoe lechenie intrakranial’nyh arahnoidal’nyh kist u detej. ZHurnal «Nevrologii i psihiatrii». 2019;119(5):121–122. (In Russ.).

22. Odintsova G., Samochernykh K. A., Samochernykh N. K., Nikolaenko M. S. Arachnoid cyst management in children. Journal of the Neurological Sciences. 2019;405S;51–52. https://doi.org/10.1016/j.jns.2019.10.312

23. Mamathanov M. R., Ushanov V. V., Gerasimov A. P., Hachatryan V.A. Hirurgicheskoe lechenie MR-negativnoj farmakorezistentnoj epilepsii u detej. Epilepsiya i paroksizmal’nye sostoyaniya. 2022;14(2):195–203. https://doi.org/10.17749/2077–8333/epi.par.con.2022.110 (In Russ.).

24. Kushen M. C., Frim D. Placement of subdural electrode grids for seizure focus localization in patients with a large arachnoid cyst. Neurosurg Focus. 2007;22:3–5. https://doi.org/10.3171/foc.2007.22.2.5

25. Sajko T., Hecimovic H., Boric M., Sesar N., Rotim K. Complete resolution of medically refractory temporal lobe epilepsy after arachnoid cyst fenestration, Acta Clin. Croatica 50 (2011) 589-593. PMID: 22649891