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A Journal on Surgery

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Chirurgia 2013 June;26(3):253-8

language: English

Interhemispheric arachnoid cyst presenting with dementia treated by direct surgery: a case report and review of the literature

Fukunaga A. 1, Shimizu K. 2, Ochiai M. 3, Yazaki T. 1

1 Department of Neurosurgery, Kyosai Tachikawa Hospital, Tachikawa City, Tokyo, Japan;
2 Department of Neurosurgery, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan;
3 Department of Neurosurgery, Nakanishi Clinic, Akishima City, Tokyo, Japan


Arachnoid cysts (ACs) occur in up to 1% of the normal population. However, interhemispheric ACs are rare and there have been only 10 cases of elderly patients with symptomatic interhemispheric ACs reported in the English or Japanese literature. This paper clearly illuminates the 5 concerns of interhemisperic AC in the elderly and suggests an adequate treatment for a symptomatic interhemispheric AC case. We present the case of a 69-year-old woman with memory disturbance. A magnetic resonance (MR) imaging revealed multiple lobular cystic lesions in the frontal interhemishere. A fractional anisotropy map of MR imaging suggested the existence of the corpus callosum. A radical membranectomy plus fenestration into the right anterior ventricle under the guidance of a navigation system was carried out. Normalization of the frontal lobes and ventricle structure was observed in a series of postoperative CT scans. No regrowth of the AC has been detected on any postoperative MR images for over 2 years and dementia has resolved. Interhemispheric AC in the elderly raises the following 5 concerns: (1) association with complete or partial agenesis of the corpus callosum, (2) surgical treatment, (3) cognitive function, (4) cystic fluid composition, (5) histology. A membranectomy plus fenestration by direct operation under navigation was an effective treatment for a giant interhemispheric AC.

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