They were thin-walled and compressed the surrounding nerve trunks to a variable degree. All lesions consisted of distinct, space-occupying cysts with a sharp boundary with surrounding tissues. Small remnants of the capsule that are firmly attached to important neurovascular structures should be left in place rather than risk neurological deficits. In this series, three intracanalicular arachnoid cysts were found in the internal auditory canal and one in the facial nerve canal. The endoscope-assisted microsurgical technique enables a safe cyst resection with good visualization of important neurovascular structures within the internal auditory canal. The histological examination confirmed the diagnosis of an arachnoid cyst. Adherent vestibular nerve fibers in the cyst wall prevented total removal of the cyst. The cyst wall was fenestrated and partially resected in an endoscope-assisted microsurgical technique. ![]() Magnetic resonance imaging revealed a cystic lesion in the internal auditory canal appearing hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting an arachnoid cyst. This case illustrates the beneficial aspect of endoscopic assistance in microsurgical resection of this lesion.Ī slowly progressive hearing loss developed in a 35-year-old woman over 2 years she reported experiencing tinnitus for 7 years. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been reported. All rights reserved.An arachnoid cyst confined to the internal auditory canal is a rare condition. Definitive pathologicdiagnosis should be strongly considered to help tailor treatment.Īcoustic neuroma Arachnoid cyst Cavernous hemangioma Cochlear schwannoma Facial schwannoma Intermedius schwannoma Internal auditory canal Lipochoristoma Meningioma Mucosa-associated lymphoid tissue (MALT) lymphoma.Ĭopyright © 2016 Elsevier Inc. internal auditory canal (IAC) and a component protruding in the CPA. Five-year average follow-up revealed one patient with recurrence.Ĭlinical examination and imaging alone were insufficient to correctly identify these tumors. arachnoid cyst can be made (compare to Fig. Few complications occurred, including facial nerve palsy, loss of hearing, and vestibular function. Three operative approaches were used: the retrosigmoid approach, middle fossa subtemporal approach, or translabyrinthine approach. None of these rare tumors could be identified before surgery. Rare IAC tumors are not all radiosensitive and are poorly described.īetween 19, 289 consecutive patients with IAC lesions operated on were reviewed retrospectively.įifteen patients (5.2%) (16 operations) had unusual histologic findings, including nonvestibular schwannomas (2 facial schwannomas, 2 cochlear schwannomas, 2 intermedius schwannomas), 3 meningiomas, 3 cavernous hemangiomas, a mucosa-associated lymphoid tissue lymphoma, an arachnoid cyst, and a lipochoristoma. Many undergo stereotactic radiation without definitive tissue diagnosis. Electronic address: 95% of tumors occurring within the internal auditory canal (IAC) are vestibular schwannomas. ![]() 6 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.Electronic address: 1 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA Department of Neurosurgery, Hôpital Lariboisirère, Paris VII-Diderot University, Paris, France. 5 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA Department of Neurosurgery, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan.4 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA Department of Neurosurgery, Fukushima Takanori Skull Base Center, Shinyurigaoka General Hospital, Kanagawa, Japan.3 Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Duke Otolaryngology of Raleigh, Raleigh, North Carolina, USA.Several surgical techniques have been proposed but no surgeons have used the minimally assisted endoscope retrosigmoid approach for its removal. 2 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Arachnoid cyst in the internal auditory canal is a quite rare pathology but due to its compressive action on the nerves in this district should be surgically removed.1 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA Department of Neurosurgery, Hôpital Lariboisirère, Paris VII-Diderot University, Paris, France.
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