J Korean Neurotraumatol Soc.  2010 Dec;6(2):150-153. 10.13004/jknts.2010.6.2.150.

Treatment of Chronic Subdural Hematoma with Arachnoid Cyst

• Paik HK
• Yoon SH
• Park CO
• Hyun DK

• KMID: 2106802
• DOI: http://doi.org/10.13004/jknts.2010.6.2.150

Abstract

Arachnoid cyst is a relatively common congenital intracranial lesion and often accompanies with chronic subdural hematoma. In case of coexisting with chronic subdural hematoma, arachnoid cyst is easily confused to hematoma, which may need surgical exploration. We report a case of chronic subdural hematoma accompanied with arachnoid cyst which was treated by trephination only. In addition, we report the radiologic features of this patient.

Keyword

Chronic subdural hematoma; Arachnoid cyst; Trephination

MeSH Terms

Arachnoid
Hematoma
Hematoma, Subdural, Chronic
Humans

Figure

• 

  FIGURE 1 Large chronic subdural hematoma is located in left cerebral hemisphere, with underlying associated arachnoid cyst (arrows) in left temporal lobe and superimposed hematoma.

• 

  FIGURE 2 Before operation, magnetic resonance image shows multi-staged chronic subdural hematoma in left cerebral hemisphere with hemorrhagic arachnoid cyst in left temporal lobe. It reveals iso-signal intensity with subdural hematoma and arachnoid cyst. The arrows demonstrate the location of the arachnoid cyst and asterisks indicate chronic subdural hematoma.

• 

  FIGURE 3 Post-operative computed tomography image shows decreased amount of chronic subdural hematoma. Arachnoid cyst density was changed to cerebrospinal fluid density. The arrows indicate arachnoid cyst and asterisk demonstrates the border between two lesions.

• 

  FIGURE 4 This figure shows magnetic resonance image which was taken two years after the operation. Chronic subdural hematoma was nearly disappeared, but still remained small amount of subdural hematoma in left cerebral hemisphere. And arachnoid cyst (arrows) with hemorrhage in left temporal lobe was decreased. Intracystic signal intensity is same as cerebrospinal fluid signal intensity.

Reference

1. Albuquerque FC, Giannotta SL. Arachnoid cyst rupture producing subdural hygroma and intracranial hypertension: case reports. Neurosurgery. 1997; 41:951–955. discussion 955-956.

2. Aoki N, Sakai T. Intraoperative subdural hematoma in a patient with arachnoid cyst in the middle cranial fossa. Childs Nerv Syst. 1990; 6:44–46.

3. Auer LM, Gallhofer B, Ladurner G, Sager WD, Heppner F, Lechner H. Diagnosis and treatment of middle fossa arachnoid cysts and subdural hematomas. J Neurosurg. 1981; 54:366–369.

4. Bilginer B, Onal MB, Oguz KK, Akalan N. Arachnoid cyst associated with subdural hematoma: report of three cases and review of the literature. Childs Nerv Syst. 2009; 25:119–124.

5. Chan JY, Huang CT, Liu YK, Lin CP, Huang JS. Chronic subdural hematoma associated with arachnoid cyst in young adults: a case report. Kaohsiung J Med Sci. 2008; 24:41–44.

6. Czernicki T, Marchel A, Nowak A, Bojarski P. [Arachnoid cysts of the middle cranial fossa presented as subdural hematomas]. Neurol Neurochir Pol. 2005; 39:328–334.

7. Domenicucci M, Russo N, Giugni E, Pierallini A. Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment. J Neurosurg. 2009; 110:1250–1255.

8. Domenicucci M, Russo N, Giugni E, Pierallini A. Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment. J Neurosurg. 2009; 110:1250–1255.

9. Fuentes S, Palombi O, Pouit B, Bernard C, Desgeorges M. [Arachnoid cysts of the middle fossa and associated subdural hematoma. Three case reports and review of the literature]. Neurochirurgie. 2000; 46:376–382.

10. Galassi E, Tognetti F, Pozzati E, Frank F. Extradural hematoma complicating middle fossa arachnoid cyst. Childs Nerv Syst. 1986; 2:306–308.

11. Harsh GR 4th, Edwards MS, Wilson CB. Intracranial arachnoid cysts in children. J Neurosurg. 1986; 64:835–842.

12. Helland CA, Wester K. A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry. 2007; 78:1129–1135.

13. Hong JC, Kim MS, Chang CH, Kim SH. Arachnoid cyst with spontaneous intracystic hemorrhage and chronic subdural hematoma. J Korean Neurosurg Soc. 2008; 43:54–56.

14. Lund E, Buhl M, Miletic T, Knudsen V. Isodense middle fossa arachnoid cyst and subdural hematoma: a diagnostic problem on CT. J Neuroradiol. 1987; 14:89–93.

15. Mayr U, Aichner F, Bauer G, Mohsenipour I, Pallua A. Supratentorial extracerebral cysts of the middle cranial fossa. A report of 23 consecutive cases of the so-called temporal lobe agenesis syndrome. Neurochirurgia (Stuttg). 1982; 25:51–56.

16. Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma. 2002; 19:1017–1027.

17. Oberbauer RW, Haase J, Pucher R. Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst. 1992; 8:281–286.

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

19. Page A, Paxton RM, Mohan D. A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma. J Neurol Neurosurg Psychiatry. 1987; 50:1001–1007.

20. Page AC, Mohan D, Paxton RM. Arachnoid cysts of the middle fossa predispose to subdural haematoma formation fact or fiction? Acta Neurochir Suppl (Wien). 1988; 42:210–215.

21. Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery. 1997; 40:483–490.

22. Servadei F, Vergoni G, Frattarelli M, Pasini A, Arista A, Fagioli L. Arachnoid cyst of middle cranial fossa and ipsilateral subdural haematoma: diagnostic and therapeutic implications in three cases. Br J Neurosurg. 1993; 7:249–253.

23. Smith RA, Smith WA. Arachnoid cysts of the middle cranial fossa. Surg Neurol. 1976; 5:246–252.

24. Sprung C, Armbruster B, Koeppen D, Cabraja M. Arachnoid cysts of the middle cranial fossa accompanied by subdural effusions-experience with 60 consecutive cases. Acta Neurochir (Wien). 2011; Epub.

25. van der Meché FG, Braakman R. Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and non-progressive symptoms. J Neurol Neurosurg Psychiatry. 1983; 46:1102–1107.

26. Wester K, Helland CA. How often do chronic extra-cerebral haematomas occur in patients with intracranial arachnoid cysts? J Neurol Neurosurg Psychiatry. 2008; 79:72–75.