Spontaneous subdural haemorrhage from an arachnoid cyst: a case report and literature review

Intracranial Arachnoid Cyst in Children: Clinical Presentation and Risk Factors for Surgical Intervention

INTRODUCTION

Intracranial arachnoid cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored; however, a small percentage may enlarge and require surgical intervention. This study aimed to identify clinical risk factors in patients with IAC who underwent surgery versus those who did not.

METHODS

We conducted a retrospective chart review from 2009 to 2021 at a free-standing children's hospital. A total of 230 patients diagnosed with an IAC aged 0-21 years of age were included in the study. Data on demographics, imaging, and neurological follow-up were analyzed.

RESULTS

Out of 230 patients, 45 (19.6%) underwent surgery. At time of IAC diagnosis, the surgical patients were younger (median age 1.1 years), and their median cyst volume was larger (41.7 cm3), compared to nonsurgical patients (median age 5.9 years, volume 11.8 cm3, respectively). Headache was the most common reason for initial imaging in nonsurgical patients (54/185, 29.2%) while prenatal ultrasound (11/45, 24.4%) and macrocephaly (11/45, 24.4%) were the most common reasons for surgical patients. The majority of both surgical and nonsurgical patients had the IAC incidentally found (41/45, 91.1% and 181/185, 97.8%, respectively). Surgery relieved symptoms in 38/45 (84.4%) patients. Cyst volume and age were predictors of increased odds of having surgery.

DISCUSSION/CONCLUSION

Patients who underwent surgery were younger and had larger cyst volumes at time of diagnosis. The majority of the IAC were found incidentally and remained stable over prolonged follow-up. The majority of the patients experienced relief of symptoms postsurgical intervention. There is a greater odds of having surgical treatment with decreased age and greater cyst volume at diagnosis, and therefore these patients should be monitored closely for development of symptoms indicating need for surgical intervention.

Sports Participation and Sports-Related Neurologic Injuries in Pediatric Patients With Arachnoid Cysts

BACKGROUND

Currently, there is no consensus recommendation regarding the safety of sports participation for pediatric patients with arachnoid cysts (ACs).

OBJECTIVE

To prospectively survey patients with ACs to define the risk of sports-associated neurologic injury in untreated and treated patients.

METHODS

A prospectively administered survey was given to all patients diagnosed with an AC who presented to a single pediatric neurosurgery clinic between December 2010 and December 2021. Data were recorded on demographic information, imaging characteristics, treatment, sports participation, and presence of sports-related neurologic injury. The type and date of surgery for the AC were noted if surgery was performed.

RESULTS

Of the 303 patients with completed surveys, 189 patients participated in sports, and 94 patients had prospective data available. There was no significant difference in cyst location or Galassi score between patients who did and did not participate in contact vs noncontact sports and those who did and did not experience a concussion. A cumulative total of 2700.5 seasons of sports were played (2499.7 in untreated and 200.8 in treated patients). There were 44 sports-related concussions among 34 patients: 43 in untreated patients and 1 in a treated patient. For all participants, the concussion rate was 16.3 per 1000 seasons of all sports and 14.8 per 1000 seasons of contact sports. The concussion rate after AC treatment was 4.9 per 1000 seasons of all sports. Three patients experienced sports-related AC rupture or hemorrhage, none of which required surgery or resulted in lasting neurologic symptoms or deficits.

CONCLUSION

The rates of sports-related concussion and cyst rupture in patients with AC in both treated and untreated populations were low. We advocate for a generally permissive posture toward sports participation in this population.

Computerized Tomography Texture Analysis in the Differential Diagnosis of Intracranial Epidermoid and Arachnoid Cysts

PURPOSE

This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA).

MATERIAL AND METHODS

The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances.

RESULTS

The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%.

CONCLUSION

CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.

Embolization as adjunctive treatment to achieve complete cure of ruptured arachnoid cyst associated with chronic subdural hematoma

INTRODUCTION

Chronic Subdural Hematoma (CSDH) is a rare but classical evolutive complication of arachnoid cysts (AC). Its management has rarely been evaluated to date. Several approaches have been proposed including conservative and surgical treatments. Endovascular treatment in such CSDH subtype remains poorly reported.

CASE PRESENTATION

We present here an original case of a 16 years-old-boy suffering from ruptured AC responsible for CSDH successfully treated with embolization.

CONCLUSION

Endovascular approach may be considered in the treatment of CSDH related to arachnoid cyst rupture.

Intracranial arachnoid cysts: Review of natural history and proposed treatment algorithm

Background:

With a prevalence of 1.4%, intracranial arachnoid cysts are a frequent incidental finding on MRI and CT. Whilst most cysts are benign in the long-term, clinical practice, and imaging frequency does not necessarily reflect this.

Methods:

A literature review was conducted searching the Medline database with MESH terms. This literature was condensed into an article, edited by a consultant neurosurgeon. This was further condensed, presented to the neurosurgery department at Princess Alexandra Hospital for final feedback and editing.

Results:

This review advises that asymptomatic patients with typical cysts have a low risk of cyst growth and development of new symptomatology, thus do not require surveillance or intervention. The minority of symptomatic patients or those with cysts in sensitive areas may require referral to a neurosurgeon for clinical follow-up or intervention.

Conclusion:

Greater than 94% of patients are asymptomatic, practitioners can be confident in reassuring patients of the benign nature of a potentially worrying finding. Recognizing the small number of symptomatic patients and those with cysts in areas sensitive to causing hydrocephalus is where GP decision making in conjunction with specialty input is of highest yield.

Arachnoid cyst with spontaneous intracystic hemorrhage and associated chronic subdural hematoma: A case report

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Spontaneous hemorrhage of arachnoid cyst accompanying subdural hematoma was rare.

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Surgery was the most common and effective treatment.

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Endoscopic/microsurgical fenestration or membranectomy was recommended to prevent a recurrence.

Introduction and importance

Spontaneous hemorrhage of the arachnoid cyst was rare, especially associated with chronic subdural hematoma (CSDH). In this paper, we reported successful surgical management of arachnoid cyst with spontaneous hemorrhage and associated subdural hematoma.

Case presentation

A 33-year-old female with no medical history was presented with a headache for one month prior to admission. Head computed tomography and magnetic resonance imaging showed a left hypodense middle cranial fossa arachnoid cyst and ipsilateral CSDH. The multiple-slice computed tomography with contrast showed no vascular abnormality. The patient was indicated for surgical hematoma evacuation, membranectomy, and fenestration of the arachnoid cyst. At the one postoperative month, the computed tomography showed a middle fossa arachnoid cyst with no hemorrhage. Until a postoperative year, the patient had no headache and no neurological deficits. She returned to daily activities and her work.

Clinical discussion

This event's pathogenesis was thought of as a result of tearing of the outer wall of an arachnoid cyst. The most common cause was mild head trauma; however, spontaneous rupture of the cyst wall also occurred. Surgery was the most common and effective treatment. Evacuation of CSDH was mandatory, but the strategies treatment for arachnoid cysts varied. Surgical options for arachnoid cyst included endoscopic/microsurgical fenestration, membranectomy, and even the cysto-peritoneal shunting.

Conclusion

Arachnoid cyst with spontaneous intracystic hemorrhage accompanying CSDH was an uncommon condition. Surgery was the most common and effective treatment. Besides evacuation of CSDH, endoscopic/microsurgical fenestration or membranectomy was recommended to prevent the recurrence.

Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literature review

PURPOSE

Arachnoid cysts may present with symptoms deriving from cyst rupture, usually causing intracystic hemorrhage and subdural hematoma or hygroma. Rupture is usually caused by minor trauma, spontaneous rupture is an exceptional event, and 57 cases have been described in literature. We here present and discuss the largest series of spontaneously ruptured middle fossa arachnoid cysts in order to investigate clinical presentation and best treatment available.

METHODS

We report a retrospective series of 17 pediatric patients surgically treated for middle fossa arachnoid cyst with signs of cyst rupture without a history of trauma in the previous 90 days. We describe clinical presentation, treatment, and outcome at follow-up discussing our results with a literature review including all reported cases of spontaneous rupture of middle fossa arachnoid cysts.

RESULTS

In our experience patients most frequently presented with subdural hygroma, in literature, a chronic hematoma was most frequently reported. Headache is the most reported symptom at presentation. Neurological deficits and consciousness alterations are rare. Surgical treatment may resolve brain compression only or reduce rupture recurrence risk. Conservative treatment has also been proposed. Different treatments are reported and discussed focusing on indications, contraindications, risks, and expected benefits.

CONCLUSION

We propose, when safely possible, microsurgical cyst fenestration in skull base cisterns as the treatment of choice for these patients as long as it addresses both immediate decompression and risk of rupture recurrence. We report good outcomes and low incidence of complications from our series with a mean postoperative follow-up of 30 months.

Spontaneous Disappearance of an Arachnoid Cyst after Burr Hole Drainage of Chronic Subdural Hematoma

It is well known that the presence of arachnoid cysts (ACs) in young patients is a risk factor for developing a chronic subdural hematoma (CSDH) after a minor head injury. Although there have been controversies with the treatment, most authors recommend only draining the CSDH if the AC is asymptomatic. This judgement is based on the facts that this surgical approach has shown good clinical outcomes, and the AC usually remains unchanged after the surgery. Our case demonstrates that the AC of a young patient who developed a CSDH after a minor head injury completely disappeared after a burr hole drainage of the CSDH. Although the chances of an AC disappearing are low, this case shows that an AC might disappear after only draining a CSDH when a rupture of the AC membrane is identified. In such cases, we recommend first draining only the CSDH for the treatment of AC-associated CSDHs.

Arachnoid cysts with spontaneous intracystic hemorrhage and associated subdural hematoma: Report of management and follow-up of 2 cases

Arachnoid cysts are one of the most frequently encountered intracranial space-occupying lesions in daily neurosurgery and neuroradiology practice. Majority of arachnoid cysts, particularly those of smaller sizes, have a benign uneventful lifetime course. Certain symptoms may indicate serious complications related to underlying arachnoid cysts. Hemorrhage is one of the most fearsome complications of arachnoid cysts and almost all reported cases in the literature have undergone surgical correction. In this study, we aimed to present clinical and radiologic follow-up findings in two adult cases of intracranial arachnoid cyst with spontaneous intracystic hemorrhage and associated subdural hematoma, one of which was successfully treated conservatively. In addition, we broadly summarized and discussed pertinent studies in the English literature.

Giant arachnoid cyst associated with acute subdural haematoma: A case report

Arachnoid cysts are extra-cerebral, intra-arachnoidal cerebrospinal fluid collections - the most frequent congenital developmental intracranial cystic lesions. They are often diagnosed incidentally during imaging exams acquired for different reasons, and are usually asymptomatic. Rare complications are post-traumatic rupture with consequent subdural haematomas. Spontaneous bleeding should be acknowledged as a rare but possible complication of this benign lesion. We report on the case of a patient presenting with a giant arachnoid cyst extending to the left frontal, temporal and parietal lobes associated with acute subdural haematoma without history of trauma.