Spontaneous Resolution of a Prepontine Arachnoid Cyst

Filho

et al. 2007

Arq. Neuro-Psiquiatr.

-Arachnoid cysts (AC) are extra-cerebral cerebrospinal fluid collections of unknown origin. They correspond to 1% of all intracranial nontraumatic space-occupying lesions and appear more frequently in the middle fossa (50%). More than 25% of these cysts are incidental findings and the majority of patients are asymptomatic. Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion. AC rupture and bleeding are rare, usually occurring in young adults and associated with trauma. The risk of hemorrhage does not exceed 0.04% / year. We describe the case of a ten-year-old boy who presented with acute signs of intracranial hypertension secondary to a spontaneous acute subdural hematoma, contralateral to an AC of the middle fossa. Three factors were significant in this case: signs and symptoms occurred spontaneously; the presence of an acute subdural hematoma exclusively contralateral to the AC; successful outcome of the conservative treatment.KEY WORDS: arachnoid cyst, subdural hematoma, pediatric neurosurgery. Hematoma subdural agudo espontâneo contralateral a cisto aracnóideoRESUMO -Os cistos aracnóideos (CA) são coleções liquóricas extra-cerebrais e intra-aracnóideas de origem desconhecida. Correspondem a 1% de todas as lesões expansivas intracranianas não traumáticas e têm ní-tido predomínio na fossa média (50%). Até 25% destes cistos são achados incidentais sendo que a maioria dos pacientes é assintomática. Crises epilépticas, sinais de hipertensão intracraniana, déficits neurológicos focais, macrocrania, atraso no desenvolvimento e abaulamento da calota craniana são os principais sinais e sintomas da lesão. A ruptura dos CA, assim como seu sangramento, são situações raras, geralmente associadas a traumas e acometem adultos jovens. O risco de hemorragia em pacientes com CA não excede 0,04% ao ano. É descrito caso de paciente de dez anos de idade que subitamente apresentou sinais de hipertensão intracraniana secundários a hematoma subdural agudo espontâneo, contralateral a volumoso CA de fossa média. Três fatores foram de relevância neste paciente: a ocorrência de sinais e sintomas espontaneamente, especialmente em um menino; presença de hematoma subdural agudo exclusivamente contralateral ao CA; e a boa evolução com o tratamento conservador. PALAVRAS-CHAVE: cisto aracnóideo, hematoma subdural, neurocirurgia pediátrica.

Section: Discussionmentioning

confidence: 98%

Spontaneous acute subdural hematoma contralateral to an arachnoid cyst

Filho

et al. 2007

Arq. Neuro-Psiquiatr.

“…15,52,53,81 Some have speculated that a change in local intracranial pressure (ICP) as a result of a Valsalva maneuver may also lead to cyst rupture with hygroma, although unrecognized or unrecorded trauma may also explain some of these cases. 9,15,19,42 A tear in the cyst lining allowing communication between an arachnoid cyst and an associated subdural hygroma has been documented intraoperatively on at least 4 occasions. 9,15,28,83 Hygromas undoubtedly result in elevated ICP in many cases.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,48,60,73 There are reports of cysts arising de novo, 57,63,71 as well as cysts becoming larger or smaller over time, 50,65,67 and even spontaneously resolving. 19,35,67,74,80,82 We recently reported on the natural history of these lesions in children 2 and adults 1 and found a generally benign natural history.…”

mentioning

confidence: 99%

Management of subdural hygromas associated with arachnoid cysts

Maher¹,

Garton²,

Al-Holou³

et al. 2013

PED

Object Arachnoid cysts may occasionally be associated with subdural hygromas. The management of these concurrent findings is controversial. Methods The authors reviewed their experience with arachnoid cysts and identified 8 patients with intracranial arachnoid cysts and an associated subdural hygroma. The medical records and images for these patients were also examined. Results In total, 8 patients presented with concurrent subdural hygroma and arachnoid cyst. Of these 8 patients, 6 presented with headaches and 4 had nausea and vomiting. Six patients had a history of trauma. One patient was treated surgically at the time of initial presentation, and 7 patients were managed without surgery. All patients experienced complete resolution of their presenting signs and symptoms. Conclusions Subdural hygroma may lead to symptomatic presentation for otherwise asymptomatic arachnoid cysts. The natural course of cyst-associated subdural hygromas, even when symptomatic, is generally benign, and symptom resolution can be expected in most cases. The authors suggest that symptomatic hygroma is not an absolute indication for surgical treatment and that expectant management can result in good outcomes in many cases.

“…Ocho de los casos publicados estaban situados en la región silviana 2,9,11,[13][14][15][16]18 donde en general, asientan el 50% de todos los QA; dos se localizaban en otros puntos de la convexidad 11,17 y otros dos estaban alojados en la fosa craneal posterior 4,12 . El proceso de resolución de los quistes fue gradual en 8 casos y en un período de tiempo que osciló entre 6 meses y 10 años 2,4,9,11,[13][14][15]18 , aunque en ocasiones no existen estudios de imagen intermedios entre el diagnóstico y su resolución 10,12,16,17 .…”

Section: Tabla 1 Casos Previos De Resolución Espontánea De Quistes Arunclassified

“…El proceso de resolución de los quistes fue gradual en 8 casos y en un período de tiempo que osciló entre 6 meses y 10 años 2,4,9,11,[13][14][15]18 , aunque en ocasiones no existen estudios de imagen intermedios entre el diagnóstico y su resolución 10,12,16,17 .…”

Section: Tabla 1 Casos Previos De Resolución Espontánea De Quistes Arunclassified

Resolución espontánea de quiste aracnoideo intracraneal asintomático

2008

Recibido:361 Neurocirugía 2008; 19: Resumen Los quistes aracnoideos son lesiones benignas, de origen congénito y de localización extraparenquimatosa, que con frecuencia se diagnostican de forma incidental en niños y adultos. Su etiología e historia natural no están perfectamente establecidas en la actualidad. La introducción de la tomografía computarizada y resonancia magnética han condicionado un incremento en el número de casos diagnosticados, muchos de ellos de forma incidental. En la literatura existen algunas referencias sobre la desaparición espontánea de quistes aracnoideos intracraneales.Presentamos el caso clínico de un quiste aracnoideo silviano que se redujo progresivamente hasta su resolución a lo largo de un período de 13 años. Revisamos los casos publicados previamente y analizamos los posibles mecanismos causante de su resolución espontánea.PALABRAS CLAVE: Fosa craneal media. Quiste aracnoideo. Resonancia magnética. Resolución espontánea. Spontaneous resolution of an asymptomatic intracranial arachnoid cyst SummaryArachnoid cysts are commonly considered to be benign, congenial, extraparenchymatous anomalies. Small cyst are common incidental findings in children and adults. The aetiology and natural history of arachnoid cysts are not fully understood. In most cases, the presence of the cysts is detected on CT-scans or MRI performed for other reasons. In the literature, there have been few documented cases of arachnoid cysts with spontaneous regression. We reports the case of a silvian arachnoid cyst, which disappeared spontaneously during the 13-year-follow-up period. We review the cases previously reported and the mechanisms underlying the resolution of the arachnoid cysts are discussed.