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Case Reports
. 2015 Jan 20:6:7.
doi: 10.4103/2152-7806.149611. eCollection 2015.

Symptomatic foramen of Magendie arachnoid cyst in an elderly patient

Yasuhiko Hayashi  1 , Daisuke Kita  1 , Takuya Watanabe  1 , Akifumi Yoshikawa  1 , Jun-Ichiro Hamada  1
Affiliations
Case Reports

Symptomatic foramen of Magendie arachnoid cyst in an elderly patient

Yasuhiko Hayashi et al. Surg Neurol Int. .

Abstract

Background: Arachnoid cysts (ACs) are congenital anomalies of the central nervous system and arise in virtually all locations where the arachnoid membrane exists. Posterior fossa ACs are considered to develop in the posterior aspect of the rhombencephalic roof plate and do not communicate freely with the fourth ventricle or perimedullary subarachnoid space. Although posterior fossa ACs have been reported a number of times, ACs arising from the foramen of Magendie are very rare.

Case description: We report here on a 76-year-old female who presented with progressive gait disturbance. Magnetic resonance imaging of the head showed a large AC in the foramen of Magendie that was compressing the inferior vermis and medial aspects of the cerebellar hemisphere without causing hydrocephalus. Neurological examination revealed cerebellar ataxia without Romberg's sign. A nearly total excision of the cyst was safely performed via a median suboccipital approach. The patient's postoperative course was excellent and her neurological recovery was remarkable.

Conclusion: Most cases of ACs located in the foramen of Magendie are reported in children, and it is extremely rare to observe such ACs in the elderly. In fact, to our knowledge, a symptomatic foramen Magendie AC has never been reported previously in an elderly person. Our results indicate that proper surgical intervention can yield highly positive outcomes in such cases.

Keywords: Arachnoid cyst; elderly; foramen of Magendie; midline; posterior fossa.

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Figures

Figure 1
Figure 1
(a) Axial section of preoperative magnetic resonance imaging (MRI) on T2-weighted image (WI) reveals a cyst with isointensity to cerebrospinal fluid (CSF) located behind the medulla oblongata along the midline. (b) Sagittal section of preoperative MRI on fast imaging with steady state acquisition (FIESTA) shows the cyst to be composed of two portions, attached to the choroid plexus, and compressing both cerebellar hemispheres
Figure 2
Figure 2
Intraoperative microscopic view after the removal of the small cyst at the outer membrane reveals that the cyst is located between the two hemispheres (a), and the part of the cyst wall was attached to the choroid plexus (b)
Figure 3
Figure 3
Photomicrograph demonstrating the cyst wall to be composed of a collagenous membrane lined by a single layer of arachnoid cells (hematoxylin and eosin; original magnification ×200)
Figure 4
Figure 4
(a) Axial section of postoperative MRI on T2-WI reveals that the cyst cavity has markedly reduced such that the CSF flow artifact can be seen clearly. (b) Sagittal section of postoperative MRI on FIESTA shows the residual CSF space in the foramen of Magendie
See this image and copyright information in PMC

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