Surgical treatment of a large arachnoid cyst with multiple complications

Abstract

introduction Arachnoid cysts are common among the general population. Best treatment option is still the subject of much debate. Surgical options include open-craniotomy or endoscopic cyst fenestration, cysto-peritoneal shunt insertion, or marsupialization via craniotomy. The aim of this article was to present a patient with an extremely large arachnoid cyst which occupied almost the entire left hemisphere. Case outline The patient with a large symptomatic arachnoid cyst was treated by craniotomy and open fenestration. The patient suffered multiple postoperative complications, such as imidiate intracerebral hemorrhage due to hypertension, obstructive hydrocephalus, and a fresh ulcer in the bulbus duodeni. All the complications were successfully treated. Conclusion Since the best treatment option is still the subject of much debate, we think that personalized medical approach is the best one, taking into account patient symptoms, localization and size of the cyst, patient's general condition, and surgeon's familiarity with the procedure.

Primary arachnoid cyst - an early postoperative complication after microsurgical resection

“…The rapid decompression with the craniotomy produces a rapid rise in cerebral perfusion, and changes in the intracranial dynamics with venous hyperemia resulting in consecutive parenchymal hemorrhage distant from the site of operation due to "shift of the brain". This is the explanation for intraparenchymal hemorrhage in the report of Živković N. et al 13 Bahl Anuj et al have shown that intraparenchymal hemorrhage in remote areas following the evacuation of a large AC indicates that chronic high cerebral perfusion pressure exists and there is a poor local auto-regulatory response surrounding an AC. It has been postulated that this complication probably represents a reperfusion injury similar to the normal perfusion pressure breakthrough syndrome following surgery for arterio-venous malformations.…”