PMC8769454_01
Preoperative CT showing a huge cyst in the left frontal lobe with several calcified lesions (A). Preoperative brain MRI showing the intra-axial cyst in the left frontal lobe. The cyst fluid showing the same intensity as cerebrospinal fluid on T1-weighted (B), FLAIR (C), and T2-weighted (E) images. The cyst existing adjacent to the left lateral ventricle without brain edema on T2-weighted images (F, G). No enhanced lesion on gadolinium- enhanced T1-weighted image (D). CT: computed tomography, FLAIR: fluid-attenuated inversion recovery, MRI: magnetic resonance imaging.
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F1
Computed tomography (CT) demonstrated a huge cyst in the left frontal lobe and several calcified lesions surrounding the cyst wall (Fig. 1A). No contrast enhancement nor perilesional edema were shown (Fig. 1B-1G).
Intraoperative endoscopic images. The fenestration from the cyst to the ventricle by neuronavigation probe (A). The expansion of the fenestrated hole by the balloon (B). The appropriate communication from the cyst to the lateral ventricle (C). The lateral ventricle bulging to the cyst after cyst fenestration (D). The white calcified nodule (E) and biopsy of the lesion (F). Microscopic view of the cyst wall showing columnar and ciliated epithelial cells constructing simple epithelial layer (G). Immunohistochemical staining showing positive for cytokeratin (H). Microscopic view of the calcified lesion showing a brain tissue (arrow) between the ciliated epithelial layer and the calcified lesion (I).
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Tokyo, Japan) with the guidance of the navigation system (StealthStation; Medtronic, Fridley, MN, USA) because the lateral ventricle could not be seen through the cyst (Fig. 2A). The fenestrated hole was expanded by the balloon (Fig. 2B). The communication from the cyst to the lateral ventricle was achieved (Fig. 2C) and the lateral ventricle bulged to the cyst after fenestration (Fig. 2D). The white calcified nodule was identified and removed with forceps (Fig. 2E and 2F). The T-shaped gelatine sponge (Spongel; LTL Pharma, Tokyo, Japan) was packed into the trajectory, and the wound was closed with a burr hole button. The epithelial cells were columnar and ciliated (Fig. 2G). On the immunohistochemical staining, the cyst wall cells were positive for cytokeratin (Fig. 2H). The white nodule lesion showed calcification under the epithelium (Fig. 2I).
Postoperative MRI showing the cyst shrinkage and fenestration (arrowhead) 3 days after the operation (A, B). Further shrinkage of the cyst 3 months after the surgery (C, D). MRI: magnetic resonance imaging.
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The postoperative MRI showed shrinkage of the cyst (Fig. 3A and 3B). 3-month later MRI showed further shrinkage of the cyst although the fenestration became unclear (Fig. 3C and 3D).