Large intradiploic arachnoid cyst of the skull in child-a case report and new terminology proposition

Abstract

We present a rare finding of the arachnoid matter invaginating into the base of middle cranial fossa and creating an abnormal space. Presented entity was incidentally found in head CT scan of 12-year-old male. Based on the radiological characteristics in CT scans and MR images, the diagnosis of intradiploic arachnoid cyst (AC) was suggested. After surgical intervention and histopathological analysis of the specimen, the diagnosis was confirmed. We assume this is the first description of large intrasphenoid AC without any traumatic or iatrogenic cause. The literature provides many different terms for the phenomenon. We are proposing the term intradiploic arachnoid diverticulum as the more accurate for capturing the essence of the phenomenon. It provides clear differentiation of the entities from classical arachnoid cysts since they are of different anatomical localization (intradural vs. extradural) and etiopathogenesis. Management with arachnoid diverticulum is not yet established, but observation with serial imaging studies should be recommended as primary management in case of asymptomatic cyst. When cyst is symptomatic, surgical treatment may be required.

Keywords: Arachnoid membrane; CSF collection; Growing skull fracture; Intracranial cyst.

Fig. 1

Preoperative non-enhanced head CT scan axial cross-section (a) with white dotted line marking level of the coronal section (b). Cyst is marked with red arrows

Fig. 2

Preoperative head MRI T1W contrast-enhanced scan on axial cross-section (a) with white dotted line marking level of the sagittal cross-section (b) of the T2W image. Cyst is marked with red arrows

Fig. 3

Intraoperative view. Characteristic craniometrical points and lines such as pterion (circle), coronal suture (intermittent line), squamous suture (dotted line), and superior temporal line (continuous line) were marked on the skull (a). Pterional craniotomy was performed, and periosteal flap was preserved (b). After dissection and mobilization of the dura, intradiploic space was visualized. Cyst is marked with white arrows (c)