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      Rapid brain shift, remote site hemorrhage, and a spinal hematoma after craniotomy for a large arachnoid cyst

      case-report

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          Abstract

          Arachnoid cysts are prevalent among the general population. The management options of symptomatic arachnoid cysts each have their own merits and disadvantages. We report a case where a large arachnoid cyst was treated by open fenestration and marsupialization that was complicated by remote intraparenchymal and spinal subdural hemorrhage. The potential physiological changes underlying these complications as well as the related literature are reviewed.

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          Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature.

          M Domenicucci, R. Delfini, P Ciappetta … (1999)
          Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. Spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.
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            Transient hyperemia immediately after rapid decompression of chronic subdural hematoma.

            K Koshu, A Ogawa, Annie Ogasawara … (1999)
            Intracerebral hemorrhage occurring after removal of a chronic subdural hematoma (CSH) is a rare but usually devastating postoperative complication. In patients with CSH, we determined cerebral blood flow immediately after surgical decompression to clarify the pathogenic mechanism of this complication. In 22 patients with unilateral CSH, a catheter was inserted into the hematoma cavity through a single burr hole without leakage of the contents. Cerebral blood flow was measured using single-photon emission computed tomography 1 day before surgery, immediately after rapid decompression by opening the catheter, and 3 days after surgery. Single-photon emission computed tomography imaging immediately after decompression demonstrated areas of hyperemia in nine patients (41%). In all nine patients, hyperemia was observed in the cortex beneath the CSH, and it disappeared on the 3rd postoperative day. The patients with hyperemia were significantly older than those without hyperemia. Other variables, including preoperative cerebral blood flow, intrahematoma pressure before decompression, and mean arterial blood pressure during decompression had no significant effect on the occurrence of hyperemia. In elderly patients, rapid decompression of CSH frequently results in transient hyperemia in the cerebral cortex beneath the hematoma.
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              A population-based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in children.

              Christian Helland, Knut Wester (2006)
              If, when, and how children with arachnoid cysts should undergo surgery has been a matter of debate. In the present study the authors describe long-term clinical and neuroimaging results in children with intracranial arachnoid cysts, treated in accordance with the authors' policy of performing surgery in most of these cases. The study included 48 pediatric patients (age < 16 years of age) who underwent surgery for treatment of an arachnoid cyst at Haukeland University Hospital between January 1987 and September 2004. Forty-one patients underwent cyst fenestration to the basal cisterns and posterior fossa. Long-term results were assessed retrospectively on the basis of medical and neuroimaging records. Additional information was obtained by means of a check-box questionnaire completed by the patients and their parents. At their follow-up examinations, 82% of the patients had no or insignificant complaints, 14% reported no improvement, and 4% noted a worsening of symptoms. In 56% of the patients with appropriate imaging for analysis, the cyst was no longer visible on neuroimaging studies. In 23%, the postoperative fluid volume was reduced to less than 50% of the original cyst volume, and in another 19%, the volume was reduced but was larger than 50% of the original. The cyst was unchanged in only 2%. There was a significant association between a volume reduction greater than 50% and clinical improvement. Three patients (6%), all with temporal cysts, had minor complications that led to additional surgery in one patient. No complications caused permanent disability. Eight patients (17%) underwent additional surgery due to suspected or demonstrated treatment failure. Most children who underwent cyst fenestration via a craniotomy experienced a good long-term outcome with no severe complications.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pediatr Neurosci
                Journal ID (iso-abbrev): J Pediatr Neurosci
                Journal ID (publisher-id): JPN
                Title: Journal of Pediatric Neurosciences
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1817-1745
                ISSN (Electronic): 1998-3948
                Publication date (Print): May-Aug 2012
                Volume: 7
                Issue: 2
                Pages: 106-108
                Affiliations
                [1]Department of Paediatric Neurosurgery, Sheffield Children's Hospital, Sheffield, United Kingdom
                [1 ]Department of Paediatric Neuro-Radiology, Sheffield Children's Hospital, Sheffield, UK
                Author notes
                Address for correspondence: Mr. Anuj Bahl, Department of Neurosurgery, Sheffield Children's Hospital, Western Bank, Sheffield S10 1PF, UK. E-mail: anujbahl3@ 123456yahoo.co.uk
                Article
                Publisher ID: JPN-7-106
                DOI: 10.4103/1817-1745.102568
                PMC ID: 3519064
                PubMed ID: 23248686
                SO-VID: e9ba5652-88eb-4e08-a674-b875ab637bfa
                Copyright © Copyright: © Journal of Pediatric Neurosciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Neurosciences
                Keywords: arachnoid cyst,brain shift,hyperperfusion,spinal subdural hematoma,cyst fenestration
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: arachnoid cyst, brain shift, hyperperfusion, spinal subdural hematoma, cyst fenestration

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