Krishnan Venkatram, Jaganathan Sriram, Baker Andrew, Jayappa Sateesh, Murphy Janice, Glasier Charles, Choudhary Arabinda, Albert Gregory, Ramakrishnaiah Raghu
Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA.
Neuroradiol J. 2024 Apr 22:19714009241248746. doi: 10.1177/19714009241248746.
Arachnoid cysts are the most common incidentally discovered intracranial lesions on imaging and the most common cystic intracranial lesions. They may be developmental or secondary. A relative lack of recent literature and any comprehensive radiological review on arachnoid cysts has led to a general lack of awareness among radiologists of symptomatic or complicated arachnoid cysts. This is particularly concerning in pediatric patients. While arachnoid cysts are asymptomatic in most cases, they can cause clinical symptoms in a minority of cases, especially when they occur in unusual sites. These include intraventricular locations where they may cause hydrocephalus, the basal cisterns where they may compress cranial nerves, the cerebellopontine angle where they have to be differentiated from a number of cystic lesions, the cavum septum pellucidum or cavum velum interpositum, the choroid fissure where they can entrap the temporal horn and compress the hippocampus, the posterior fossa where they need to be differentiated from other posterior fossa cystic lesions, and within the spinal canal where there is a concern for cord or nerve root compression. Larger cysts are more prone to complications such as mass effect, hemorrhage, and rupture. Hemorrhage and rupture often present with acute symptoms. Ruptured cysts lose their characteristic imaging appearance and can mimic several ominous pathologies. It therefore becomes vital to accurately diagnose these cases as complications of pre-existing arachnoid cysts for appropriate management. A detailed review of all diagnostic imaging aspects of arachnoid cysts will help fill in the existing information void on this important entity.
蛛网膜囊肿是影像学检查中最常见的偶然发现的颅内病变，也是最常见的颅内囊性病变。它们可能是先天性的或继发性的。近期相对缺乏关于蛛网膜囊肿的文献以及全面的影像学综述，导致放射科医生对有症状或复杂的蛛网膜囊肿普遍认识不足。这在儿科患者中尤其令人担忧。虽然蛛网膜囊肿在大多数情况下是无症状的，但在少数情况下会引起临床症状，特别是当它们发生在不寻常的部位时。这些部位包括脑室，囊肿可能在脑室导致脑积水；基底池，囊肿可能压迫颅神经；小脑脑桥角，在此处必须将其与多种囊性病变相鉴别；透明隔腔或中间帆腔；脉络膜裂，囊肿可在脉络膜裂处包绕颞叶角并压迫海马；后颅窝，在此处需要将其与其他后颅窝囊性病变相鉴别；以及椎管内，在椎管内需要关注囊肿对脊髓或神经根的压迫。较大的囊肿更容易出现诸如占位效应、出血和破裂等并发症。出血和破裂通常表现为急性症状。破裂的囊肿会失去其特征性的影像学表现，并可模仿几种严重的病变。因此，准确诊断这些病例为既往存在的蛛网膜囊肿的并发症对于进行适当的治疗至关重要。对蛛网膜囊肿所有诊断影像学方面进行详细综述将有助于填补关于这一重要疾病实体的现有信息空白。
