Childs Nerv Syst (2005) 21: 1065–1066 DOI 10.1007/s00381-005-1258-6
Y. Kusaka W. Luedemann S. Oi R. Shwardfegar M. Samii
Received: 25 May 2005 Published online: 20 October 2005 # Springer-Verlag 2005
CASE ILLUSTRATI ON
Fetal arachnoid cyst of the quadrigeminal cistern in MRI and ultrasound
W. Luedemann . R. Shwardfegar . M. Samii Department of Neurosurgery, International Neuroscience Institute, Alexis Carrel Strasse 4, 30625 Hannover Germany S. Oi Division of Pediatric Neurosurgery, Women’s and Children’s Medical Center, Jikei University Hospital, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan
Y. Kusaka (*) Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan e-mail:
[email protected] Tel.: +81-3-34331111 Fax: +81-3-34596412
Abstract Case: The authors report a fetus with an arachnoid cyst of the quadrigeminal cistern without hydrocephalus at 30 gestational weeks. Discussion and conclusion: We reviewed the literature and could find only 62 reported cases of arachnoid cyst of the quadrigeminal cistern. We
Introduction Arachnoid cysts of quadrigeminal cistern is rare, and so far only 62 cases (including this case) have been reported in the literature [3–5, 8, 9]. Occasionally, they induce symptoms when they are large enough to obliterate the cerebrospinal fluid (CSF) outflow pathway and give rise to noncommunicating hydrocephalus [3, 4, 6–9]. Typically, patients show symptoms of increased intracranial pressure or pressure against the tectum and/or the brain stem [4, 9]. In the literature, the patients’ age range between 3 weeks and 71 years [3]. Prenatal ultrasound (US) and magnetic resonance imaging (MRI) have led to increased diagnosis of fetus central nervous system (CNS) abnormalities. Since arachnoid cysts are anomalies, they can be evaluated during pregnancy by ultrasound examination and/or MRI,
present a case without hydrocephalus diagnosed by combining ultrasound (US) and magnetic resonance imaging (MRI). The fetus, born by normal delivery, was followed up and did not show hydrocephalus for 1 year. This combined prenatal study, which uses US and MRI, helps in dispensing proper counseling to parents and assists the gynecologist and the neurosurgeon in the pre- and postnatal management of this condition. Keywords Fetal archnoid cyst . Quadrigeminal cistern . Ultrasound . MRI
if they are large enough for it. We present the first report of a fetal arachnoid cyst of quadrigeminal cistern without hydrocephalus diagnosed via US and MRI. Ultrasound revealed an anechoic mass in the quadrigeminal cistern without hydrocephalus in the 30-week-old fetal brain. The cyst appeared on T2-weighted MR images at 31 weeks as a large midline cystic mass with isointensity to CSF. The cyst compressed the third ventricle and bilateral occipital lobes. On sagittal MRI, the obstruction of the cerebral aqueduct was not identified. In addition, no communication between the ventricular system and the cyst was observed (Fig. 1). We conducted a follow-up study on the subject, who was diagnosed with an arachnoid cyst of the quadrigeminal cistern without obstruction of the CSF pathway. The baby was born by normal delivery and has not shown hydrocephalus.
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Fig. 1 T2-weighted axial MR image (a) demonstrating a large arachnoid cyst at quadrigeminal cistern (asterisk) without hydrocephalus and third ventricle (black arrow). The coronal image (b),
revealing bilateral occipital lobes compressed by the cyst. The obstruction of cerebral aqueduct can not be detected on sagittal image (c) (white arrows)
Discussion and conclusions
atomical details and diagnostic confidence as it has superior tissue resolution than US. This combined prenatal study helps in dispensing proper counseling to parents and assists the gynecologist and the neurosurgeon in the preand postnatal management of this condition.
Prenatal ultrasonography can identify intracranial spaceoccupying lesions larger than 10 mm [2]. Occasionally, a fetus diagnosed with arachnoid cyst via US examination alone is terminated [1]. MRI is useful to delineate an-
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