Middle fossa arachnoid cyst presenting an interesting clinical course: a case report

The mechanism of the disappearance of arachnoid cysts is not fully understood. We report a case of arachnoid cyst which disappeared after head injury. A 28-year-old male was found to have an arachnoid cyst in the left middle fossa following head injury. We followed him up, because he had no symptoms. Two weeks later, he suffered from severe headache. CT image showed a dilatation of the subdural space, and his symptom deteriorated. We performed subdural-perifocal shunt, but one month after, he developed a subdural hematoma. The subdural hematoma was irrigated through a burr hole. His symptom disappeared post operatively. Two months later, CT image showed the disappearance of subdural hematoma and the arachnoid cyst. This case suggested one of the mechanisms involved in the disappearance of arachnoid cyst after head injury.     

Heading injury precipitating subdural hematoma associated with arachnoid cysts--two case reports.

A 14-year-old boy and a 11-year-old boy presented with subdural hematomas as complications of preexisting arachnoid cysts in the middle cranial fossa, manifesting as symptoms of raised intracranial pressure. Both had a history of heading the ball in a soccer game about 7 weeks and 2 days before the symptom occurred. There was no other head trauma, so these cases could be described as "heading injury." Arachnoid cysts in the middle cranial fossa are often associated with subdural hematomas. We emphasize that mild trauma such as heading of the ball in a soccer game may cause subdural hematomas in patients with arachnoid cysts.     

Roller coaster headaches revisited

BACKGROUND: Roller coasters are probably one of the more popular rides at amusement parks around the world. Despite their relative safety, nontraumatic intracranial injuries have been reported following roller coaster rides. The presence of an intracranial arachnoid cyst may increase the risk of nontraumatic injury in this setting. CASE DESCRIPTION: We describe a 33-year-old female with a left middle fossa arachnoid cyst who presented with increasing headaches from bilateral subdural hygromas after a roller coaster ride. The patient underwent bilateral burr hole drainage of her subdural hygromas with resolution of her symptoms. CONCLUSION: This case demonstrates the potential risks of intracranial injury in patients with an underlying arachnoid cyst who engage in certain types of recreational activity.     

Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst

Chronic subdural hematoma (CSDH) tends to occur in elderly patients with a history of mild head injury at a few months prior to the onset of symptoms. Intracranial arachnoid cyst is believed to be congenital and sometimes becomes symptomatic in pediatric patients. These two distinct clinical entities sporadically occur in the same young patient. Twelve of 541 cases of CSDH surgically treated in our institution had associated arachnoid cyst. The clinical and radiological characteristics of the cases of CSDH associated with arachnoid cyst were retrospectively analyzed and compared with those of CSDH without arachnoid cyst. Arachnoid cysts were located in the middle fossa (eight cases), convexity (two cases), and posterior fossa (two cases). Three cysts were less than 20 mm in diameter. The 12 patients with CSDH and arachnoid cyst (mean age 27.8 +/- 19.7 years) were significantly younger (p < 0.001) than the patients with CSDH without arachnoid cyst (69.5 +/- 13.7 years). Five of the 12 patients were pediatric cases (< 15 years old). The clinical symptoms were also significantly different. The most frequent symptom was headache followed by vomiting in the patients with arachnoid cyst, while gait disturbance and hemiparesis predominated in patients without arachnoid cyst. Hematoma evacuation through burr holes improved the symptoms in all patients with arachnoid cyst. We conclude that even a small arachnoid cyst can be a risk factor for CSDH after mild head injury in young patients and symptoms of increased intracranial pressure are common. Hematoma evacuation is adequate at first operation. If the preoperative symptoms persist, additional arachnoid cyst surgery should be considered. The present results also suggest that CSDH formation may be preceded by subdural hygroma caused by the rupture of arachnoid cyst.     

Chronic subdural hematoma associated with arachnoid cyst. Two case histories with pathological observations

Arachnoid cysts are well known to induce chronic subdural hematoma (CSDH) after head injury. However, histological observations of the arachnoid cyst and hematoma membrane have only been rarely described. An 8-year-old boy and a 3-year-old boy presented with CSDH associated with arachnoid cyst. Surgical removal of the hematoma and biopsy of the hematoma membrane and cyst wall were performed. Clinical courses were good and without recurrence more than 1.5 years after surgery. Histological examination suggested that the cysts did not contribute to hematoma development. Pediatric hematoma membranes, similar to adult hematoma membranes, are key in the growth of CSDH. Therefore, simple hematoma evacuation is adequate as a first operation for CSDH associated with arachnoid cyst.     

Arachnoid cysts of the middle fossa and associated subdural hematoma. Three case reports and review of the literature

BACKGROUND AND PURPOSE: We report 3 cases of subdural hematoma associated with arachnoid cyst of the middle fossa, and discuss the treatment. METHODS: Three males aged 33, 63 and 68 were treated in our institution. Before this event the cyst was asymptomatic and unknown. Magnetic resonance imaging was the most contributive radiologic exam. Surgical procedure was limited to subdural hematoma evacuation. The internal wall of subdural hematoma was opened in all cases. RESULTS: The clinical outcome was good for all patients. The CT or MRI scan follow-up 3 months later revealed nearly total disappearance of subdural hematoma for 2 out of 3 cases. For one patient the volume of arachnoid cyst decreased. CONCLUSIONS: We propose subdural hematoma drainage without any specific treatment (shunt or fenestration) of the arachnoid cyst, for this category of patient.     

Subacute subdural hematoma associated with moyamoya phenomenon--a case report

A case of subacute subdural hematoma associated with moyamoya phenomenon is reported. On May 8, 1986, a 61-year-old female was referred to Mito National Hospital for evaluation of a left-sided hemiparesis and headache 8 days after minor head injury. Seventeen years ago she experienced the sudden onset of a left-sided hemiparesis which improved by rehabilitation. CT scans showed a thin high density area on the right cerebral convexity and a small low density area in the right semiovale center. On May 12, she was admitted because of aggravation of her symptoms. A repeat CT scan showed an enlarged right temporoparietal subdural hematoma with significant mass effect. Cerebral angiograms revealed the occlusion of right internal carotid artery. There were so-called moyamoya vessels bilaterally and transdural anastomosis on the right side. Avascular area confirmed subdural hematoma. The hematoma was evacuated via two burr holes with preservation of the middle meningeal and superficial temporal arteries. By the time of discharge two months postoperatively, she was walking well without assistance. We reviewed four cases of acute or subacute subdural hematoma associated with moyamoya phenomenon and emphasized the possibility of occurrence of acute or subacute subdural hematoma due to rupture of vault moyamoya vessels.     

颅内蛛网膜囊肿术后并发症分析

目的研究颅内蛛网膜囊肿手术治疗后并发症及防治。方法对47例患者施行手术治疗,术式包括蛛网膜囊肿部分切除、囊肿开放脑池穿通术、蛛网膜囊肿部分切除术、内镜下囊肿脑池穿通术及蛛网膜囊肿-腹腔分流术。结果所有手术后患者均获得良好疗效,与囊肿手术有关的并发症主要有剧烈头痛和高热,裂隙脑室综合征和硬膜下血肿。结论对引起临床症状的颅内蛛网膜囊肿应积极手术治疗,与囊肿有关的并发症有其特殊性,做到术中操作细致,术后严密观察,对此类并发症是可以预防和治愈的。     

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

Introduction and importanceSpontaneous 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 presentationA 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 discussionThis 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.ConclusionArachnoid 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.     

Surgical treatment for symptomatic arachnoid cysts

During the period from 1983 to 1999, 12 patients with symptomatic arachnoid cyst were treated. The mean patient age was 20.6 years. The most common location was the middle fossa (10 cases). Initial CT scan revealed associated subdural hygroma in 7 patients and hydrocephalus in one. Clinical symptoms were related to increased intracranial pressure, cranio-megaly and seizure. One infant with a huge arachnoid cyst was treated, using a cystoperitoneal (CP) shunt. Four patients underwent membraectomy. Combination CP shunt and membraectomy was performed in 5 patients. The remaining 2 arachnoid cysts were complicated with subdural hygroma and, initially, they were observed conservatively, but hygroma gradually changed to hematoma. One was treated by irrigation and the other hematoma was spontaneously absorbed. Significant complications included extensive subdural effusion in one patient, contralateral chronic subdural hematoma in two, intracranial hypotension in two, and shunt dependency in one. There were no recurrences during the follow-up period (mean 3.6 years).     

Spontaneous disappearance of a middle fossa arachnoid cyst associated with subdural hematoma

The case of a 7-year-old boy with a middle fossa arachnoid cyst that spontaneously disappeared is presented. Computed tomography (CT) scan revealed an arachnoid cyst in the right middle fossa with a thin subdural hematoma on the same side. As the subdural hematoma spontaneously resolved, the cyst became smaller and finally disappeared without surgical intervention after 18 months on the follow-up CT scans. Possible mechanisms of the spontaneous disappearance of an arachnoid cyst are discussed.     

Temporal lobe lesions in head injury

Summary In cases of closed head injury temporal lobe lesionse.g. contusion, laceration, pulping, or intracerebral haematoma frequently result in an expanding process. These are frequently associated with an overlying subdural haematoma. Eighty five cases of such lesions from a consecutive series of 1,000 cases of head injury have been analyzed. The lesions are caused by severe injury resulting in loss of concsiousness and skull fracture. Most of them are contre-coup lesions. Clinically they manifest themselves like any other acute or subacute intracranial hematoma. The majority of the patients have contralateral hemiparesis and pupillary abnormalities. Carotid angiography is valuable for diagnosis. These lesions are likely to be missed when exploratory burr holes are made or, are erroneously diagnosed as acute subdural haematoma or brain oedema. Smaller lesions, not showing progressive deterioration, may respond to conservative treatment. However, surgical decompression is essential in most cases. A fronto-temporal osteoplastic craniotomy or a large Scoville trephine hole is essential to deal with these lesions adequately.     

Double-endoscopic approach for management of convexity arachnoid cyst: case report

BACKGROUND: Controversy exists about the best treatment modality for arachnoid cysts. Widely accepted neurosurgical options include craniotomy with open resection of the cyst walls, shunting procedures and stereotactic fenestration of the cyst cavity. Recently, neuroendoscopic approach showed its effectiveness for treatment of these lesions. CASE DESCRIPTION: In the presented case the large convexity arachnoid cyst was diagnosed in a 22-year-old woman with head dullness and local bone bulging. No neurologic signs were found. Surgery was performed by double-neuroendoscopic approach with simultaneous use of two flexible ventriculofiberscopes, which permitted wide resection of the inner cyst wall. Complete resolution of symptoms was noted soon after surgery. CONCLUSION: Double-endoscopic approach might be useful for complex neuroendoscopic procedures that need different simultaneous surgical actions, particularly for cases of large arachnoid cysts.     

Two cases of symptomatic arachnoid cysts in elderly patients--a comparison and analysis with child cases

A symptomatic arachnoid cyst in an elderly patient is rare. We report two cases of symptomatic arachnoid cysts in elderly patients. The first case is that of a 73-year-old woman complaining of headache and speech disturbance. She had an arachnoid cyst in the left interhemispheric fissure. This is rare. Only two interhemispheric arachnoid cysts in the elderly have ever been reported. The other case is that of a 64-year-old woman, having right hemiparesis and dementia and a cyst is shown in her left temporal lobe. Both patients underwent a cystectomy which resulted in the disappearance of their symptoms. Only 56 cases of symptomatic arachnoid cyst over the age of 60 years have ever been reported. We made an analysis of 58 cases, including our two cases, and compared it with child cases. In cases of the elderly, the symptoms are usually headache, hemiparesis, gait disturbance and dementia, which are similar to symptoms of chronic subdural hematoma and normal pressure hydrocephalus. On the other hand, child cases usually reveal signs of intracranial hypertension. Several authors have reported their therapeutic method for child symptomatic arachnoid cysts. However, it is difficult to determine the best method for treating child cases at this time. We think a cystectomy is the first choice of operative procedure for symptomatic arachnoid cyst in the elderly.     

Subdural hygroma as a complication of endoscopic neurosurgery--two case reports

Two cases of subdural hygroma occurred in a series of 77 neuroendoscopic procedures. An 8-year-old boy underwent neuroendoscopic cysto-cisternostomy of a left temporal arachnoid cyst. Routine postoperative magnetic resonance imaging 7 days later showed a large left-sided subdural hygroma without clinical symptoms. During the following 3 months, the subdural hygroma did not resolve spontaneously, so it was drained through a burr hole. A 3-month-old boy with aqueductal stenosis developed bilateral subdural hygromas after third ventriculostomy. Several punctures through the open anterior fontanelle relieved the hygromas but increasing head circumference required ventriculoperitoneal shunting 12 months later. Complications of neuroendoscopic procedures are increasingly reported, including various kinds of bleeding, infections, or damage of neuronal tissue. Only three previous cases of subdural hygroma or hematoma after neuroendoscopic interventions have been reported. The possible etiologies and clinical consequences of this rare complication have to be considered before selecting neuroendoscopy treatment.     

Successful surgical treatment of a hemophiliac infant with nontraumatic acute subdural hematoma

BACKGROUND: The moderate hemophiliacs usually have no spontaneous bleeding, but bleed after minor or major trauma. The proper management of intracranial hemorrhage in hemophiliac children is a challenge. CASE DESCRIPTION: An 18-month-old male infant with moderate hemophilia A was admitted with fever, vomiting, and hypersomnia. There was no history of trauma or seizure. The CT scans showed an acute subdural hematoma in the right temporoparietooccipital region with midline shift and a coincidental right cerebellar arachnoid cyst. After bolus factor VIII replacement, a right temporoparietal craniotomy was performed, and the subdural hematoma was evacuated. The postoperative CT scans demonstrated no hematoma. CONCLUSIONS: The possibility of intracranial hemorrhage in a moderate hemophiliac infant should be considered even if the patient has no history of trauma. The surgical treatment results in a successful outcome in hemophiliac children with subdural hematomas provided that an aggressive factor replacement therapy is initiated before surgery.     

Dissapearance of arachnoid cyst after rupturing into subdural space

Summary Arachnoid cysts are developmental anomalies usually diagnosed in childhood. The most important complications of arachnoid cysts are subdural haematomas and hygromas and intracystic haemorrhage. In our case we present a 7-year-old boy whose arachnoid cyst ruptured into the subdural space following a mild head injury and disappeared after draining the subdural haematoma by burr-holes.     

Transdural metastasis from adenocarcinoma of the prostate mimicking subdural hematoma: case report

BACKGROUND: Metastasis of prostatic adenocarcinoma to the nervous system is extremely rare and has been infrequently reported over the last several years. We describe the presentation, evaluation, and surgical intervention of a case of metastatic prostate carcinoma to the dura. CASE DESCRIPTION: This patient presented with symptoms and physical findings consistent with a subacute subdural hematoma in the setting of recently diagnosed adenocarcinoma of the prostate. He underwent a craniotomy for presumed subdural hematoma. The pathologic diagnosis was consistent with metastatic prostatic carcinoma. CONCLUSION: This case report demonstrates the need for broad differential diagnosis in the evaluation and treatment of patients presenting with seemingly straightforward subacute subdural hematomas.     

Clinical study on intracranial arachnoid cyst: with reference to the middle cranial fossa

Thirty-two cases of congenital arachnoid cyst (AC), 26 cases of supratentorial, and 6 cases of infratentorial cyst are reported. They were encountered over a period of 9 years. The 26 supratentorial cysts consisted of 21 cases located in the middle fossa, 2 in the frontal, and 3 in the suprasellar. Patients' ages ranged from 7 months to 67 years (mean: 19.3 years), with a male to female ratio of 23:9. The most common symptoms were headache, epileptic seizure, and cranial enlargement. Based on observations between neuroradiological examinations including analysis of the cyst content, and operation, typical AC might be defined as "duplicated arachnoid and its splitting", and it may be said that "there is continuous existence of cerebral structure such as cortex and white matter lying adjacent to AC on MRI". Out of 32 cases, 15 received surgical treatment because of mass effect of AC itself, abnormal dynamics of the AC fluid, and/or increasing sign of ICP. 13 cases had resection of AC outer membrane with craniotomy, and the remaining two had cystoperitoneal shunt. One of the shunting cases complicated subdural hematoma. Surgical treatment was discussed and radical craniotomy rather than a shunt procedure was preferred. Prognosis of all cases was favorable and uneventful.