Imaging and hemodynamic study of epilepsy induced by space-occupying intracranial arachnoid cyst_West China Medical Journal

Authors：

LI Wanling ¹ , XIA Yilin ¹ , XU Xiao ² , LI Zhongyou ³ ,  CHEN Lei ^1,4 ,  CHEN Yu ³

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Mechanics, University of Science and Technology of China, Anhui, Hefei 230026, P. R. China;
3. Department of Mechanics, School of Architecture and Environment, Sichuan University, Chengdu, Sichuan 610065, P. R. China;
4. Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHEN Lei, Email: leilei_25@126.com; CHEN Yu, Email: yu_chen@scu.edu.cn

Keywords：

Epilepsy; arachnoid cyst; imaging; hemodynamics

DOI：

10.7507/1002-0179.202102134

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Objective To investigate the correlation of intracranial arachnoid cyst (IAC) with epilepsy and the possible mechanism of seizure induced by IAC. Methods Patients with IAC, who were treated in West China Hospital of Sichuan University between January 2009 and January 2019, were included and divided into IAC with epilepsy group and IAC without epilepsy group according to whether they were diagnosed with epilepsy. We collected the IAC location information of all subjects after the establishment of a three-dimensional spatial coordinate system of MRI images. Computational fluid dynamics technology was used to establish a blood vessel model in cyst area and perform hemodynamic analysis basing on contrast-enhanced CT images. Results A total of 72 patients were enrolled, including 24 in the IAC with epilepsy group and 48 in the IAC without epilepsy group. There was no significant difference between the two groups in terms of sex, age, IAC location, the volumes or the maximum diameters of IAC (P>0.05). Consecutive areas formed by the seven high-risk areas found in the IAC with epilepsy group were located in the temporal area. The seven high-risk areas were simultaneous IAC location in 5 patients in the IAC with epilepsy group and in 1 patient in the IAC without epilepsy group, and the difference was statistically significant (χ²=5.114, P=0.024). Comparison of the hemodynamic parameters between the two types of vascular models revealed similar pressure changes and blood pressure parameters, with lower blood flow and higher mean vascular wall shear stress in the IAC with epilepsy group. Conclusions IAC may cause epilepsy by increasing adjacent blood vessel stenosis and blood vessel wall shear stress through cyst space-occupying effect. The most common location of IAC with epilepsy is the temporal area. The occupying effect of IAC should be considered in the location of epileptogenic foci before surgery for IAC patients with epilepsy.

Citation： LI Wanling, XIA Yilin, XU Xiao, LI Zhongyou, CHEN Lei, CHEN Yu. Imaging and hemodynamic study of epilepsy induced by space-occupying intracranial arachnoid cyst. West China Medical Journal, 2022, 37(11): 1641-1645. doi: 10.7507/1002-0179.202102134 Copy

1.	Orduna MJ, Lopez PJ, Curto SB, et al. Intracranial arachnoid cysts and epilepsy in children: should this be treated surgically? Our 29-year experience and review of the literature. Neurocirugia (Astur: Engl Ed), 2022, 33(4): 157-164.
2.	席東海. 顱內蛛網膜囊腫的診斷和治療. 大家健康(下旬版), 2015(7): 125-126.
3.	Devinsky O, Vezzani A, O’Brien TJ, et al. Epilepsy. Nat Rev Dis Primers, 2018, 4: 18024.
4.	Trinka E, Kwan P, Lee B, et al. Epilepsy in Asia: disease burden, management barriers, and challenges. Epilepsia, 2019, 60(Suppl 1): 7-21.
5.	Del Brutto OH, Mera RM, Kiernan J, et al. Supratentorial arachnoid cysts and seizures/epilepsy: a population study in community dwellers aged ≥20 years. Epilepsia, 2019, 60(8): e83-e87.
6.	Rabiei K, Jaraj D, Marlow T, et al. Prevalence and symptoms of intracranial arachnoid cysts: a population-based study. J Neurol, 2016, 263(4): 689-694.
7.	Nikoli? I, Risti? A, Vojvodi? N, et al. The association of arachnoid cysts and focal epilepsy: hospital based case control study. Clin Neurol Neurosurg, 2017, 159: 39-41.
8.	Gui SB, Wang XS, Zong XY, et al. Assessment of endoscopic treatment for middle cranial fossa arachnoid cysts. Childs Nerv Syst, 2011, 27(7): 1121-1128.
9.	Spacca B, Kandasamy J, Mallucci CL, et al. Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres. Childs Nerv Syst, 2010, 26(2): 163-172.
10.	Couvreur T, Hallaert G, Van Der Heggen T, et al. Endoscopic treatment of temporal arachnoid cysts in 34 patients. World Neurosurg, 2015, 84(3): 734-740.
11.	Yeaton-Massey A, Monteagudo A. Intracranial cysts. Am J Obstet Gynecol, 2020, 223(6): B42-B46.
12.	Sajko T, He?imovi? H, Bori? M, et al. Complete resolution of medically refractory temporal lobe epilepsy after arachnoid cyst fenestration. Acta Clin Croat, 2011, 50(4): 589-593.
13.	Amin OS. Late onset seizures and progressive cognitive decline: is it an arachnoid cyst?. BMJ Case Rep, 2013, 2013: bcr2013009847.
14.	林堃, 林元相. 蛛網膜囊腫所致癲癇致癇機制及手術方式探討//第五屆 CAAE 國際癲癇論壇論文集. 重慶: 中國抗癲癇協會, 2013: 537.
15.	Koch CA, Moore JL, Voth D. Arachnoid cysts: how do postsurgical cyst size and seizure outcome correlate?. Neurosurg Rev, 1998, 21(1): 14-22.
16.	張毅, 連亞軍. 蛛網膜囊腫與癲癇研究進展. 中國實用神經疾病雜志, 2014, 17(19): 121-122.
17.	Weinand ME, Carter LP, El-Saadany WF, et al. Cerebral blood flow and temporal lobe epileptogenicity. J Neurosurg, 1997, 86(2): 226-232.
18.	Okada Y, Hamano K, Iwasaki N, et al. Epilepsy accompanied by intracranial arachnoid cysts: studies on volume and regional cerebral blood perfusion using MRI and SPECT. J Epilepsy, 1998, 11(4): 195-201.
19.	Cucullo L, Hossain M, Puvenna V, et al. The role of shear stress in blood-brain barrier endothelial physiology. BMC Neurosci, 2011, 12: 40.
20.	L?scher W, Friedman A. Structural, molecular, and functional alterations of the blood-brain barrier during epileptogenesis and epilepsy: a cause, consequence, or both?. Int J Mol Sci, 2020, 21(2): 591.

1. Orduna MJ, Lopez PJ, Curto SB, et al. Intracranial arachnoid cysts and epilepsy in children: should this be treated surgically? Our 29-year experience and review of the literature. Neurocirugia (Astur: Engl Ed), 2022, 33(4): 157-164.
2. 席東海. 顱內蛛網膜囊腫的診斷和治療. 大家健康(下旬版), 2015(7): 125-126.
3. Devinsky O, Vezzani A, O’Brien TJ, et al. Epilepsy. Nat Rev Dis Primers, 2018, 4: 18024.
4. Trinka E, Kwan P, Lee B, et al. Epilepsy in Asia: disease burden, management barriers, and challenges. Epilepsia, 2019, 60(Suppl 1): 7-21.
5. Del Brutto OH, Mera RM, Kiernan J, et al. Supratentorial arachnoid cysts and seizures/epilepsy: a population study in community dwellers aged ≥20 years. Epilepsia, 2019, 60(8): e83-e87.
6. Rabiei K, Jaraj D, Marlow T, et al. Prevalence and symptoms of intracranial arachnoid cysts: a population-based study. J Neurol, 2016, 263(4): 689-694.
7. Nikoli? I, Risti? A, Vojvodi? N, et al. The association of arachnoid cysts and focal epilepsy: hospital based case control study. Clin Neurol Neurosurg, 2017, 159: 39-41.
8. Gui SB, Wang XS, Zong XY, et al. Assessment of endoscopic treatment for middle cranial fossa arachnoid cysts. Childs Nerv Syst, 2011, 27(7): 1121-1128.
9. Spacca B, Kandasamy J, Mallucci CL, et al. Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres. Childs Nerv Syst, 2010, 26(2): 163-172.
10. Couvreur T, Hallaert G, Van Der Heggen T, et al. Endoscopic treatment of temporal arachnoid cysts in 34 patients. World Neurosurg, 2015, 84(3): 734-740.
11. Yeaton-Massey A, Monteagudo A. Intracranial cysts. Am J Obstet Gynecol, 2020, 223(6): B42-B46.
12. Sajko T, He?imovi? H, Bori? M, et al. Complete resolution of medically refractory temporal lobe epilepsy after arachnoid cyst fenestration. Acta Clin Croat, 2011, 50(4): 589-593.
13. Amin OS. Late onset seizures and progressive cognitive decline: is it an arachnoid cyst?. BMJ Case Rep, 2013, 2013: bcr2013009847.
14. 林堃, 林元相. 蛛網膜囊腫所致癲癇致癇機制及手術方式探討//第五屆 CAAE 國際癲癇論壇論文集. 重慶: 中國抗癲癇協會, 2013: 537.
15. Koch CA, Moore JL, Voth D. Arachnoid cysts: how do postsurgical cyst size and seizure outcome correlate?. Neurosurg Rev, 1998, 21(1): 14-22.
16. 張毅, 連亞軍. 蛛網膜囊腫與癲癇研究進展. 中國實用神經疾病雜志, 2014, 17(19): 121-122.
17. Weinand ME, Carter LP, El-Saadany WF, et al. Cerebral blood flow and temporal lobe epileptogenicity. J Neurosurg, 1997, 86(2): 226-232.
18. Okada Y, Hamano K, Iwasaki N, et al. Epilepsy accompanied by intracranial arachnoid cysts: studies on volume and regional cerebral blood perfusion using MRI and SPECT. J Epilepsy, 1998, 11(4): 195-201.
19. Cucullo L, Hossain M, Puvenna V, et al. The role of shear stress in blood-brain barrier endothelial physiology. BMC Neurosci, 2011, 12: 40.
20. L?scher W, Friedman A. Structural, molecular, and functional alterations of the blood-brain barrier during epileptogenesis and epilepsy: a cause, consequence, or both?. Int J Mol Sci, 2020, 21(2): 591.

West China Medical Journal

Imaging and hemodynamic study of epilepsy induced by space-occupying intracranial arachnoid cyst

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