|Year : 2017 | Volume
| Issue : 3 | Page : 194-196
Arachnoid cyst with bilateral subdural hygroma: Rare case report
Maddala Sundeep1, Mustafa Ghulam Faisal2, Syed Abdul Jaleel Kirmani2, Mortha Premjit Ray2
1 Department of Neurosurgery, Citizens Hospital, Hyderabad, Telangana, India
2 Osmania General Hospital, Hyderabad, Telangana, India
|Date of Web Publication||25-Sep-2017|
Department of Neurosurgery, Citizens Hospital, Nallagandla, Serilingampally, Hyderabad - 500 019, Telangana
Source of Support: None, Conflict of Interest: None
Arachnoid cysts are benign, congenital, nonneoplastic, extra-axial, intra-arachnoid lesions filled with similar to or exactly like cerebrospinal fluid. These cysts are reported to account for at least 1% of all intracranial mass lesions. Most patients present during the first two decades of life; however, presentation during adulthood is not uncommon. Arachnoid cysts are often discovered as incidental findings on cranial imaging. Surgical treatment of arachnoid cysts with bilateral subdural hygroma is controversial. We report a rare presentation of an arachnoid cyst with bilateral subdural hygroma.
Keywords: Arachnoid cyst, craniotomy, subdural hygroma
|How to cite this article:|
Sundeep M, Faisal MG, Kirmani SA, Ray MP. Arachnoid cyst with bilateral subdural hygroma: Rare case report. J NTR Univ Health Sci 2017;6:194-6
|How to cite this URL:|
Sundeep M, Faisal MG, Kirmani SA, Ray MP. Arachnoid cyst with bilateral subdural hygroma: Rare case report. J NTR Univ Health Sci [serial online] 2017 [cited 2020 Apr 9];6:194-6. Available from: http://www.jdrntruhs.org/text.asp?2017/6/3/194/215524
| Introduction|| |
Arachnoid cysts are benign, congenital, nonneoplastic, extra-axial, intra-arachnoid lesions filled with similar to or exactly like cerebrospinal fluid (CSF). Although they may present at any age, 60-80% of arachnoid cysts are discovered in children, with overall male-to-female ratio of 2:1 to 3:1. Arachnoid cysts may be completely asymptomatic or present with a myriad of symptoms. We report a rare presentation of an arachnoid cyst with bilateral subdural hygroma with papilledema.
| Case Report|| |
A 4-year-old male child presented with complaints of headache, visual blurring, and projectile vomiting of 6 days duration. The child had a history of trivial fall while playing at school about 6 days prior to onset of headache, with no loss of consciousness. On examination, child was conscious, coherent with normal higher mental functions. His visual acuity was 6/6 in both eyes, no visual field defects. Fundoscopy showed bilateral papilledema. Other cranial nerves examinations were normal. There were no motor and sensory deficits. Deep tendon reflexes were 2+, with bilateral plantars down going. All routine biochemical investigations were within normal limits. Computed tomography (CT) scan of the brain showed a hypo-dense region in the right Sylvain fissure compressing the temporal horn with bilateral subdural hygroma, bilateral diffuse cerebral edema, and mass effect causing compression of both frontal horns. Magnetic resonance imaging (MRI) of the brain showed a bilateral collection in the subdural space, hypo-intense on T1-weighted and hyper-intense on T2-weighted images in the right Sylvain fissure, matching with the intensities of CSF [Figure 1].
|Figure 1: Computed tomography scan of the brain showing hypo-dense region expanding the right Sylvain fissure with bilateral subdural hygroma/hematoma (chronic), bilateral diffuse cerebral edema, and mass effect causing compression of both frontal horns|
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Right pterional craniotomy, evacuation of hygroma, fenestration of the cyst into basal cisterns, and marsupialization of the cyst was performed. Postoperatively child developed pseudomeningocele, which was managed by tapping and compression dressings for 1 week and was discharged without any deficits. Postoperative imaging demonstrated a reduction in cyst size and subdural hygroma, with no ventricular compression and mass effect [Figure 2].
|Figure 2: The postoperative computed tomography scan showed resolution of the subdural hygroma and significant decrease in mass effect with small extradural and subgaleal collection of the cerebrospinal fluid|
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| Discussion|| |
Arachnoid cysts constitute about 1% of all nontraumatic intracranial space-occupying lesions. The formation of arachnoid cysts is hypothesized to result from abnormal embryonic development. A slit-valve or ball-valve communication may exist between the subarachnoid space and the cyst. CT cisternography or cine-phase contrast-enhanced MRI sequences often demonstrate slow filling or emptying of the arachnoid cyst.
Majority of the arachnoid cysts are discovered incidentally and remain stable over many years while some disappear spontaneously. Subdural rupture of the arachnoid cyst per se, either traumatic or spontaneous, is sparingly reported.,,, Clinical presentation varies primarily by age and location. The most common presenting symptom is headache, which may be due to local mass effect, raised intracranial pressure, or hydrocephalus, or may be unrelated to the co-existing cyst.
Arachnoid cysts are most commonly located in the middle cranial fossa. Galassi et al. classified middle fossa and Sylvain fissure cysts into three types on the basis of their CT appearance and apparent communication with adjacent normal CSF spaces. The present case is type II cyst, quadrangular-appearing involving up to mid aspect of the Sylvain fissure.
Symptomatic arachnoid cysts may be surgically treated by various modalities such as craniotomy and fenestration, cystoperitoneal shunt or endoscopic marsupialization.,, We performed craniotomy and cyst excision with microsurgical fenestration in this patient as there was bilateral subdural hygroma with symptoms of raised intracranial pressure, which needed emergency decompression.
| Conclusion|| |
Arachnoid cyst rupture causing subdural hygroma is rare. Spontaneous rupture with bilateral subdural hygroma is very rare. Management of arachnoid cyst with bilateral subdural hygroma is controversial. Symptomatic patients are surgical candidates. Microsurgical fenestration by means of a craniotomy is a safe and effective method for the treatment of middle fossa arachnoid cysts.
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