Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment

Clinical article

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Object

Arachnoid cysts are relatively common congenital intracranial mass lesions that arise during the development of the meninges. They can be complicated by the formation of an ipsilateral chronic subdural hematoma (CSDH) after minor cranial trauma. Treatment of these coexisting conditions remains controversial. In this study the authors describe the anatomical, clinical, and neuroradiological features and outcome in a series of patients whose CSDH associated with arachnoid cysts were managed surgically by draining the hematoma alone and leaving the cyst intact. The authors based this surgical management on histological and neuroradiological observations concerning these associated medical conditions.

Methods

A series of 8 patients with CSDHs associated with arachnoid cysts underwent surgery to drain the hematoma though a bur hole. The arachnoid cyst was left intact. Postoperative follow-up included CT scanning and T1- and T2-weighted MR imaging.

Results

Clinical, anatomical, and radiological observations suggest that because separate membranes cover arachnoid cysts and the related hematoma, arachnoid cysts remain unaffected by the subdural bleeding. In the present study, these observations received support from the neuroimaging appearances, suggesting that arachnoid cysts related to hematoma contained only blood breakdown products from the hematoma that had filtered through the reciprocal dividing membranes.

Conclusions

Arachnoid cysts associated with SDH are anatomically separate conditions whose neurological symptoms respond to surgical drainage of the CSDH alone.

Abbreviations used in this paper: AC = arachnoid cyst; CDSH = chronic subdural hematoma; CSF = cerebrospinal fluid.

Article Information

Address correspondence to: Maurizio Domenicucci, M.D., Via A. Graf, 42 - 00137, Rome, Italy. email: smcapone@libero.it.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Axial T1-weighted MR imaging studies. A: Preoperative image demonstrating the hematoma in the subdural space, which appears as a mixed, markedly and moderately high-intensity area; the AC appears markedly hyperintense. B: Postoperative image obtained 1 month after surgery showing the middle fossa AC appearing nonhomogeneously isointense to brain parenchyma. C: Postoperative image obtained 6 months after surgery showing that the signal intensity of the AC in the left middle fossa has changed and is now isointense with CSF.

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    Imaging studies. Preoperative coronal T1-weighted MR image showing the hematoma in the left frontotemporal and parietal subdural space appearing as a markedly high-intensity area and the middle fossa AC in the middle fossa appearing isointense to brain parenchyma. The contralateral middle fossa AC appears isointense with CSF. B: Postoperative CT scan obtained 2 days after surgery documenting the disappearance of the SDH, whereas both ACs appear isointense with CSF. C: Postoperative T2-weighted MR image acquired 20 days after surgery showing that both ACs in the middle fossa appear isointense to CSF. D: Postoperative T1-weighted image demonstrating that the left middle fossa AC appears isointense to the brain parenchyma, whereas the contralateral cyst is still isointense with CSF. E: On this T2-weighted FLAIR image the lesion appears hyperintense

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