Romanian Neurosurgery (Sep 2011)
Subdural hematoma and arachnoid cyst
Abstract
We present a case of a previously asymptomatic 15-year-old boy who was examined in the emergency services unit for syndrome of intracranial hypertension. He was addmited for headache, vertigo, vomiting and somnolence, GCS 14, and on local examination no traumatic signs. On admission, a CT-scan of his head revealed left fronto-temporo-parietal expansive process with important mass effect to the right. The patient underwent a left-sided craniotomy for evacuation of the subdural hematoma as well as the intracystic hematoma and cyst fenestration into the basal cisterns. The patient tolerated the procedure well and recovered completely. Intracranial arachnoid cysts are considered to be congenital malformations with a predilection for the temporal fossa. A review of clinical symptoms, etiology and mechanisms, diagnosis and treatment is made, followed by the necessary discussions. Taking into account the possible mechanisms of subdural hematomas in arachnoid cysts, in our opinion is logically to perform craniotomy with membranectomy, taking out the membrane from the vessels, in order to prevent another hemorrhage. Other authors propose subdural hematoma drainage without any specific treatment (shunt or fenestration) of the arachnoid cyst, for this category of patient. The diagnosis of a subdural hematoma superposed on a arachnoid cyst can be tricky for a doctor from other specialty or for a young neurosurgeon. It is important to identify and report such rare complications with intracranial arachnoid cyst, so that asymptomatic patients with an intracranial arachnoid cyst can be counseled about such possibilities following head trauma.
