Top

Published in:

01-11-2020 | Subdural Hematoma | Original Article

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

Authors: Alberto Balestrino, Gianluca Piatelli, Alessandro Consales, Armando Cama, Andrea Rossi, Mattia Pacetti, Pietro Fiaschi, Marco Pavanello

Published in: Child's Nervous System | Issue 11/2020

Abstract

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.

Albuquerque FC, Giannotta SL (1997) Arachnoid cyst rupture producing subdural hygroma and intracranial hypertension: case reports. Neurosurgery 41:951–956. https://doi.org/10.1097/00006123-199710000-00036CrossRefPubMed

Al-Holou WN, Yew AY, Boomsaad ZE et al (2010) Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 5:578–585. https://doi.org/10.3171/2010.2.PEDS09464CrossRefPubMed

Galassi E, Tognetti F, Frank F et al (1985) Infratentorial arachnoid cysts. J Neurosurg 63:210–217. https://doi.org/10.3171/jns.1985.63.2.0210CrossRefPubMed

Higashi S, Yamashita J, Yamamoto Y, Izumi K (1992) Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult. Surg Neurol 37:289–292. https://doi.org/10.1016/0090-3019(92)90155-gCrossRefPubMed

Hoffman HJ, Hendrick EB, Humphreys RP, Armstrong EA (1982) Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57:597–602. https://doi.org/10.3171/jns.1982.57.5.0597CrossRefPubMed

Gosalakkal JA (2002) Intracranial arachnoid cysts in children: a review of pathogenesis, clinical features, and management. Pediatr Neurol 26:93–98. https://doi.org/10.1016/S0887-8994(01)00329-0CrossRefPubMed

Adin ME, Yıldız MS, Deniz MA, Behzadi AH, Mata-Mbemba D (2018) Arachnoid cysts with spontaneous intracystic hemorrhage and associated subdural hematoma: report of management and follow-up of 2 cases. Radiol Case Reports 13:516–521. https://doi.org/10.1016/j.radcr.2017.12.006CrossRef

Parsch CS, Krauß J, Hofmann E et al (1997) Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 40:483–490. https://doi.org/10.1097/00006123-199703000-00010CrossRefPubMed

You C, Shrestha R (2014) Spontaneous chronic subdural hematoma associated with arachnoid cyst in children and young adults. Asian J Neurosurg 9:168–172. https://doi.org/10.4103/1793-5482.142739CrossRefPubMedPubMedCentral

10.

Inoue T, Matsushima T, Tashima S et al (1987) Spontaneous disappearance of a middle fossa arachnoid cyst associated with subdural hematoma. Surg Neurol 28:447–450. https://doi.org/10.1016/0090-3019(87)90228-XCrossRefPubMed

11.

Rakier A, Feinsod M (1995) Gradual resolution of an arachnoid cyst after spontaneous rupture into the subdural space: case report. J Neurosurg 83:1085–1086. https://doi.org/10.3171/jns.1995.83.6.1085CrossRefPubMed

12.

Choong CT, Lee SH (1998) Subdural hygroma in association with middle fossa arachnoid cyst: acetazolamide therapy. Brain Dev 20:319–322. https://doi.org/10.1016/S0387-7604(98)00039-4CrossRefPubMed

13.

Henriques JG, Pianetti Filho G, KSW H et al (2007) Spontaneous acute subdural hematoma contralateral to an arachnoid cyst. Arq Neuropsiquiatr 65:1034–1036. https://doi.org/10.1590/S0004-282X2007000600025CrossRefPubMed

14.

Katsaros VK, Flaskas T, Stavrinou LC et al (2008) Intracranial hemorrhagic arachnoid cyst: the role of diffusion-weighted imaging. Neuroradiol J 21:543–546. https://doi.org/10.1177/197140090802100412CrossRefPubMed

15.

Lohani S, Robertson RL, Proctor MR (2013) Ruptured temporal lobe arachnoid cyst presenting with severe back pain. J Neurosurg Pediatr 12:281–283. https://doi.org/10.3171/2013.6.PEDS13122CrossRefPubMed

16.

Marques IB, Vieira Barbosa J (2014) Arachnoid cyst spontaneous rupture. Acta Medica Port 27:137–141. https://doi.org/10.20344/amp.2017CrossRef

17.

Bora A, Yokuş A, Batur A, Bulut MD, Yavuz A, Gülşen İ, Özgökçe M, Arslan M (2015) Spontaneous rupture of the middle fossa arachnoid cyst into the subdural space: case report. Polish J Radiol 80:324–327. https://doi.org/10.12659/PJR.893928CrossRef

18.

Page A, Paxton RM, Mohan D (1987) A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural. J Neurol Neurosurg Psychiatry 50:1001–1007. https://doi.org/10.1136/jnnp.50.8.1001CrossRefPubMedPubMedCentral

19.

Rogers MA, Klug GL, Siu KH (1990) Middle fossa arachnoid cysts in association with subdural haematomas. A review and recommendations for management. Br J Neurosurg 4:497–502. https://doi.org/10.3109/02688699008993799CrossRefPubMed

20.

Oka Y, Kumon Y, Ohta S et al (1994) Chronic subdural hematoma associated with middle fossa arachnoid cysts-three case reports. Neurol Med Chir (Tokyo) 34:95–99CrossRef

21.

Ibarra R, Kesava PP (2000) Role of MR imaging in the diagnosis of complicated arachnoid cyst. Pediatr Radiol 30:329–331. https://doi.org/10.1007/s002470050751CrossRefPubMed

22.

Mori K, Yamamoto T, Horinaka N, Maeda M (2002) Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma 19:1017–1027. https://doi.org/10.1089/089771502760341938CrossRefPubMed

23.

Chan JY, Huang CT, Liu YK et al (2008) Chronic subdural hematoma associated with arachnoid cyst in young adults: a case report. Kaohsiung J Med Sci 24:41–44. https://doi.org/10.1016/S1607-551X(08)70072-XCrossRefPubMed

24.

Patel RA, Levy ML, Crawford JR (2013) Spontaneous subdural haemorrhage in a child with bilateral middle cranial fossa arachnoid cysts. BMJ Case Rep:1–2. https://doi.org/10.1136/bcr-2013-200802

25.

Kang J, Whang K, Hong S-K, Pyen JS, Cho SM, Kim JY, Kim SH, Oh JW (2015) Middle meningeal artery embolization in recurrent chronic subdural hematoma combined with arachnoid cyst. Korean J Neurotrauma 11:187–190. https://doi.org/10.13004/kjnt.2015.11.2.187CrossRefPubMedPubMedCentral

26.

Yüksel MO, Gürbüz MS, Senol M, Karaarslan N (2016) Spontaneous subdural haematoma developing secondary to arachnoid cyst rupture. J Clin Diagnostic Res 10:PD05–PD06. https://doi.org/10.7860/JCDR/2016/21056.8708CrossRef

27.

Wu X, Li G, Zhao J, Zhu X, Zhang Y, Hou K (2018) Arachnoid cyst–associated chronic subdural hematoma: report of 14 cases and a systematic literature review. World Neurosurg 109:e118–e130. https://doi.org/10.1016/j.wneu.2017.09.115CrossRefPubMed

28.

Kaszuba M, Tan L, Moftakhar R, Kasliwal M (2018) Nontraumatic subdural hematoma and intracystic hemorrhage associated with a middle fossa arachnoid cyst. Asian J Neurosurg 13:116–118. https://doi.org/10.4103/1793-5482.181124CrossRefPubMedPubMedCentral

29.

Poirrier ALML, Ngosso-Tetanye I, Mouchamps M, Misson JP (2004) Spontaneous arachnoid cyst rupture in a previously asymptomatic child: a case report. Eur J Paediatr Neurol 8:247–251. https://doi.org/10.1016/j.ejpn.2004.04.005CrossRefPubMed

30.

Cakir E, Kayhankuzeyli SOC et al (2004) Arachnoid cyst rupture with subdural hygroma: case report and literature review. Neurocirugia (Astur) 15:72–75CrossRef

31.

Gil-Gouveia R, Miguens J, Coiteiro D (2010) Rupture of middle fossa arachnoid cyst simulating new-onset migraine with aura: clinical notes. Headache 50:314–319. https://doi.org/10.1111/j.1526-4610.2009.01573.xCrossRefPubMed

32.

Khilji MF, Jeswani NL, Hamid RS, Al Azri F (2016) Spontaneous arachnoid cyst rupture with subdural hygroma in a child. Case Rep Emerg Med 2016:1–3. https://doi.org/10.1155/2016/6964713CrossRef

33.

Cullis PA, Gilroy J (1983) Arachnoid cyst with rupture into the subdural space. J Neurol Neurosurg Psychiatry 46:454–456. https://doi.org/10.1136/jnnp.46.5.454CrossRefPubMedPubMedCentral

34.

Eustace S, Toland J, Stack J (1992) CT and MRI of arachnoid cyst with complicating intracystic and subdural haemorrhage. J Comput Assist Tomogr 16:995–997. https://doi.org/10.1097/00004728-199211000-00034CrossRefPubMed

35.

Iaconetta G, Esposito M, Maiuri F, Cappabianca P (2006) Arachnoid cyst with intracystic haemorrhage and subdural haematoma: case report and literature review. Neurol Sci 26:451–455. https://doi.org/10.1007/s10072-006-0532-zCrossRefPubMed

36.

Ziaka DS, Kouyialis AT, Boviatsis EJ, Sakas DE (2008) Asymptomatic massive subdural hematoma in a patient with bitemporal agenesis and bilateral temporal arachnoid cysts. South Med J 101:324–326. https://doi.org/10.1097/SMJ.0b013e3181646a5cCrossRefPubMed

37.

Hong J-C, Kim M-S, Chang C-H, Kim S-H (2008) Arachnoid cyst with spontaneous intracystic hemorrhage and chronic subdural hematoma. J Korean Neurosurg Soc 43:54–56. https://doi.org/10.3340/jkns.2008.43.1.54CrossRefPubMedPubMedCentral

38.

Patel AP, Oliverio PJ, Kurtom KH, Roberti F (2009) Spontaneous subdural hematoma and intracystic hemorrhage in an arachnoid cyst. Radiol Case Rep 4:298. https://doi.org/10.2484/rcr.v4i3.298CrossRefPubMed

39.

Gũndũz B, Yassa MIK, Ofluoǧlu E et al (2010) Two cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage. Neurol India 58:312–315. https://doi.org/10.4103/0028-3886.63795CrossRefPubMed

40.

Hall A, White MAJ, Myles L (2017) Spontaneous subdural haemorrhage from an arachnoid cyst: a case report and literature review. Br J Neurosurg 31:607–610. https://doi.org/10.1080/02688697.2016.1187255CrossRefPubMed

41.

Aydogmus E, Hicdonmez T (2017) Spontaneous intracystic haemorrhage of an arachnoid cyst associated with a subacute subdural hematoma: a case report and literature review. Turk Neurosurg:1–5. https://doi.org/10.5137/1019-5149.jtn.20885-17.2

42.

Ergün R, Ökten AI, Beşkonakli E et al (1997) Unusual complication of arachnoid cyst: spontaneous rupture into the subdural space. Acta Neurochir 139:692–694. https://doi.org/10.1007/BF01412007CrossRefPubMed

43.

Çayli SR (2000) Arachnoid cyst with spontaneous rupture into the subdural space. Br J Neurosurg 14:568–570. https://doi.org/10.1080/02688690050206738CrossRefPubMed

44.

Galarza M, Pomata HB, Pueyrredón F et al (2002) Symptomatic supratentorial arachnoid cysts in children. Pediatr Neurol 27:180–185. https://doi.org/10.1016/S0887-8994(02)00414-9CrossRefPubMed

45.

Slaviero F, Frighetto L, Azambuja ND et al (2008) Middle cranial fossa arachnoid cysts complicated with subdural collections. Arq Neuropsiquiatr 66:913–915. https://doi.org/10.1590/S0004-282X2008000600033CrossRefPubMed

46.

Liu Z, Xu P, Li Q, Liu H, Chen N, Xu J (2014) Arachnoid cysts with subdural hematoma or intracystic hemorrhage in children. Pediatr Emerg Care 30:345–351. https://doi.org/10.1097/PEC.0000000000000128CrossRefPubMed

47.

Chandra VVR, Prasad BC, Subramanium CS, Kumar R (2015) Spontaneous intracystic hemorrhage complicating an intracranial arachnoid cyst. J Neurosci Rural Pract 6:629–630. https://doi.org/10.4103/0976-3147.169773CrossRefPubMedPubMedCentral

48.

Sener RN Arachnoid cysts associated with post-traumatic and spontaneous rupture into the subdural space. Comput Med Imaging Graph 21:341–344

49.

Levy ML (2005) Microsurgical Keyhole Approach for Middle Fossa. 56:1138–1145. https://doi.org/10.1227/01.NEU.0000155088.70249.45

50.

Xu S, Wang Y, Luo Q et al (2016) Endoscopic fenestration of twenty-six patients with middle fossa arachnoid cyst. J Craniofac Surg 27:973–975. https://doi.org/10.1097/SCS.0000000000002624CrossRefPubMed

51.

Galassi E, Tognetti F, Gaist G et al (1982) Ct scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol 17:363–369. https://doi.org/10.1016/0090-3019(82)90315-9CrossRefPubMed

52.

Al-Holou WN, Terman S, Kilburg C et al (2013) Prevalence and natural history of arachnoid cysts in adults. J Neurosurg 118:222–231CrossRef

53.

Cress M, Kestle JRW, Holubkov R, Riva-Cambrin J (2013) Risk factors for pediatric arachnoid cyst rupture/hemorrhage: a case-control study. Neurosurgery 72:716–722. https://doi.org/10.1227/NEU.0b013e318285b3a4CrossRefPubMed

54.

Zeng L, Feng L, Wang J, Li J, Wang Y, Chen J, Chen J, Lei T, Li L (2008) Comparative study on two surgical procedures for middle cranial fossa arachnoid cysts. J Huazhong Univ Sci Technol Med Sci 28:431–434. https://doi.org/10.1007/s11596-008-0412-2CrossRef

55.

Beltramello A, Mazza C (1985) Spontaneous disappearance of a large middle fossa arachnoid cyst. Surg Neurol 24:181–183. https://doi.org/10.1016/0090-3019(85)90182-XCrossRefPubMed

Title: Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literature review
Authors: Alberto Balestrino
Gianluca Piatelli
Alessandro Consales
Armando Cama
Andrea Rossi
Mattia Pacetti
Pietro Fiaschi
Marco Pavanello
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Subdural Hematoma
Craniotomy
Hematoma
Headache
Published in: Child's Nervous System / Issue 11/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-020-04560-3

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2020

Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant

Cervical myelomeningocele with CSF leakage: a case-based review

Alterations in skull base anatomy in intrauterine and postnatal repaired myelomeningoceles

Result of awake surgery for pediatric eloquent brain area tumors: single-center experience

An incidental pure arterial malformation in a child: case report and review of the literature

Ependymomas in infancy: underlying genetic alterations, histological features, and clinical outcome