Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literat
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ORIGINAL ARTICLE
Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literature review Alberto Balestrino 1,2 & Gianluca Piatelli 2 & Alessandro Consales 2 & Armando Cama 2 & Andrea Rossi 3 & Mattia Pacetti 2 & Pietro Fiaschi 1,2 & Marco Pavanello 2 Received: 13 January 2020 / Accepted: 27 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Arachnoid cysts may present with symptoms deriving from cyst rupture, usually causing intracystic hemorrhage and subdural hematoma or hygroma. Rupture is usually caused by minor trauma, spontaneous rupture is an exceptional event, and 57 cases have been described in literature. We here present and discuss the largest series of spontaneously ruptured middle fossa arachnoid cysts in order to investigate clinical presentation and best treatment available. Methods We report a retrospective series of 17 pediatric patients surgically treated for middle fossa arachnoid cyst with signs of cyst rupture without a history of trauma in the previous 90 days. We describe clinical presentation, treatment, and outcome at follow-up discussing our results with a literature review including all reported cases of spontaneous rupture of middle fossa arachnoid cysts. Results In our experience patients most frequently presented with subdural hygroma, in literature, a chronic hematoma was most frequently reported. Headache is the most reported symptom at presentation. Neurological deficits and consciousness alterations are rare. Surgical treatment may resolve brain compression only or reduce rupture recurrence risk. Conservative treatment has also been proposed. Different treatments are reported and discussed focusing on indications, contraindications, risks, and expected benefits. Conclusion We propose, when safely possible, microsurgical cyst fenestration in skull base cisterns as the treatment of choice for these patients as long as it addresses both immediate decompression and risk of rupture recurrence. We report good outcomes and low incidence of complications from our series with a mean postoperative follow-up of 30 months. Keywords Subdural hematoma . Subdural hygroma . Fenestration . Intracystic hemorrhage
Introduction Arachnoid cysts (ACs) are cerebrospinal fluid collections surrounded by an arachnoid sheet believed to be of congenital origin. They are uncommon cystic lesions that represent 1% of
* Alberto Balestrino [email protected] 1
Division of Neurosurgery, Department of Neuroscience (DINOGMI), Ospedale Policlinico San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
2
Department of Neurosurgery, IRCCS Istituto Giannina Gaslini Children’s Hospital, Genoa, Italy
3
Department of Neuroradiology, IRCCS Istituto Giannina Gaslini Children’s Hospital, Genoa, Italy
all intracranial masses [1]. Nearly half of pediatric intracranial arachnoid cysts are located in the sylvian fissure/middle cranial fossa [2], and 60–80% of arachnoid cysts are discover
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