Korean J Neurotrauma.  2019 Oct;15(2):159-163. 10.13004/kjnt.2019.15.e15.

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

• Kim DY
• Lee S
• Choi BS
• Kim JS

• KMID: 2461121
• DOI: http://doi.org/10.13004/kjnt.2019.15.e15

Abstract

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.

Keyword

Arachnoid cysts; Chronic subdural hematoma; Head injuries

MeSH Terms

Arachnoid Cysts
Arachnoid*
Craniocerebral Trauma
Drainage*
Hematoma, Subdural, Chronic*
Humans
Membranes
Risk Factors
Rupture

Figure

• 

  FIGURE 1 (A) Brain CT taken immediately after a facial contusion after the initial bicycle accident. An AC at the right high frontal convexity with an inner-skull indentation without any trauma-related lesions was observed. (B) Brain T2-weighted axial magnetic resonance imaging performed 2 months after the initial facial injury. A CSDH at the right cerebral convexity with midline shifting was observed. The signal intensities of both the AC and the CSDH were the same, and no membrane between them was observed. (C) Brain CT taken immediately after the surgery. The CSDH was well drained, and the AC showed a decrease in size with a cerebrospinal fluid-like density. (D) Follow-up brain CT scan taken 4 months after the surgery. The CSDH disappeared completely, and the size of the AC was more decreased. A change in the fluid density of the AC was noted. (E) Follow-up brain CT scan taken 7 months after the surgery. The AC had disappeared completely with full brain expansion.CT: computed tomography, AC: arachnoid cyst, CSDH: chronic subdural hematoma.

• 

  FIGURE 2 Illustrations of the AC associated with the CSDH. A CSDH (2nd step, drawn as red color) may occur either outside or inside the AC after a head injury. CSDH occurring outside (2nd step, upper), the AC would be crushed flat and rupture. CSDH occurring inside (2nd step, lower), it would expand and rupture. In either case, a connection between the cyst and the subdural space is established. After the removal of CSDH, the pressure of the AC disappears (3rd step). Gradual brain expansion follows, leading to disappearance of the AC (4th step).AC: arachnoid cyst, CSDH: chronic subdural hematoma.

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