Clinical and Radiological Effects of The Treatment Modalities in a Case of Arachnoid Cyst Rupture

Yıl 2009, Cilt: 14 Sayı: 1, 97 - 100, 01.02.2009

Halil İbrahim Seçer Selçuk Göçmen Tufan Cansever Metin Kaplan Engin Gönül

Öz

Traumatic rupture into the subdural space without evidence of hemorrhage of the arachnoid cysts that localized in middle cranial fossa is a rare anomaly. We described the clinical and radiologic findings of a case 24-year-old man who was presented with a ruptured arachnoid cyst of the middle cranial fossa , and produced a subdural hygroma with trauma. Although arachnoid cysts account for 1% of all intracranial space occupying lesions, the association between arachnoid cysts and subdural hygroma is rare and only 23 cases have been previously reported in the literature. There are two procedures used in the surgery, the first is cyst fenestration and the second is a cysto-peritoneal shunt. In this patient although we applied all the possible surgical choices and we couldn't achieve any slightest regression on radiological findings, the patient had full recovery clinically.

Anahtar Kelimeler

-

Araknoid Kist Rüptürü Olgusunda Uygulanan Tedavilerin Radyolojik ve Klinik Etkileri

Öz

Orta fossa araknoid kistlerin travma sonrası yırtılarak kanama olmaksızın subdural alana açılmaları oldukça nadir görülen bir anomalidir. Travma sonrası subdural higroma gelişen orta fossa araknoid kistli 24 yaşında erkek hastanın klinik ve radyolojik bulguları sunuldu. Araknoid kistler tüm kafa içi yer kaplayıcı lezyonların %1'ini oluşturmaktadır. Araknoid kist sonrası subdural higroma gelişimi oldukça nadir görülmektedir ve literatürde daha önce 23 vaka bildirilmiştir. Cerrahi işlem yapılırken iki yöntem kullanılmaktadır; kistin sisternalara fenestrasyonu ve kistoperitoneal şant takılması. Bu hastada her türlü cerrahi girişimi uygulamamıza rağmen, radyolojik olarak herhangi bir düzelme sağlanamamasına rağmen klinik bulgularında tamamen düzelme sağlandı.

Anahtar Kelimeler

Araknoid kist, subdural higroma, membranektomi ve fenestrasyon, kistoperitoneal şant

Kaynakça

• 1. Choux M, Raybaud C, Pinsard N, Hassoun J, Gambarelli D. Intracranial supratentorial cysts in children excluding tumor and parasitic cysts. Childs Brain. 1978; 4:15-32.
• 2. Sommer IEC, Smith LME. Congenital supratentorial arachnoidal and giand cyst in children: a clinical study with arguments for a conservative approach. Child’s Nerv Syst. 1997; 13: 8-12.
• 3. Albuquerque FC, Giannotta SL. Arachnoid cyst rupture producing subdural hygroma and intracranial hypertension: case reports. Neurosurgery. 1997; 41:951-5; discussion 955-6.
• 4. Di Rocco C. Arachnoid cysts, in Youmans JR [Ed]: Neurological Surgery. Philadelphia, W.B. Saunders Co. 1996; p. 967-994
• 5. Page A, Paxton RM, Mohan D. A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma. J Neurol Neurosurg Psychiatry. 1987; 50:1001-1007.
• 6. Passero S, Filosomi G, Cioni R, Venturi C, Volpin B. Arachnoid cyst of the middle cranial fossa; a clinical, radiological and follow-up study. Acta Neurol Scand. 1990; 82:94-100.
• 7. Von Wild K. Arachnoid cyst of the middle cranial fossa. Neurochirurgia. 1992; 35: 177-182.
• 8. Weinberg PE, Flom RA. Intracranial subarachnoid cysts. Radiology. 1973; 106:329-333.
• 9. Cilluffo JM, Onofrio BM, Miller RH. The diagnosis and surgical treatment of intracranial arachnoid cysts. Acta Neurochir[Wien]. 1983; 67:215-229.
• 10. Cakir E, Kayhankuzeyli OC, Sayin B, Peksoylu G. Karaarslan. Arachnoid cyst rupture with subdural hygroma: case report and literature review Neurochirurgia. 2003; 14:72-75.
• 11. Galassi E, Gaist G, Giuliani G, Pozzati EU. Arachnoid cysts of the middle cranial fossa: Experience with 77 cases treated surgically. Acta Neurochir Suppl [Wien]. 1988; 42:201-204.
• 12. Harsh GR IV, Edwards MSB, Wilson CB. Intracranial arachnoid cysts in children. J Neurosurg. 1986; 64:835-842.
• 13. Hayashi T, Anegawa S, Honda E, et al. Clinical analysis of arachnoid cysts in the middle fossa. Neurochirurgia [Stuttg]. 1979; 22:201-210.
• 14. Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery. 1997 Mar; 40[3]:483-90.
• 15. Raffel C, McComb JG. To shunt or to fenestrate: Which is the best surgical treatment for arachnoid cysts in pediatric patients? Neurosurgery. 1988; 23:338-342