Ruptured intracranial arachnoid cysts presented with subdural effusion or hematoma in children: clinical feature analysis and treatment outcome

Abstract

Objective To analyze the clinical features, treatment strategies and outcome of ruptured intracranial arachnoid cysts(IACs) with subdural effusions or hematoma in children. Methods From January 2003 to January 2016, 49 ruptured IACs presented with subdural effusions, subdual and/or intracystic hematoma were retrospectively reviewed at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. The operative methods including burr hole in 16 cases, craniotomy and fenestration in 5 cases, cysto-peritoneal shunt (CPS) in 20cases, were indicated according to symptomatic presentation or significant radiological criteria. Eight cases were treated conservatively. Results The average age of the patients was 7.2±4.7 years, with the dominance of male(78%) and Galassi typeⅡ(53%) middle fossa(94%) IACs. The traumatic history was provided in 26(53%) cases. Raptured IAC were manifested as subdual and/or intracystic hemorrhage in 27(55%) and subdural effusion in 22(45%) patients. After a mean follow-up of 59.1 months in 47 patients, 3 cases disappeared spontaneously, 0 increased in size and all patients have symptomatic improvement. However, 14 of 30 burr hole need reoperation, with craniotomy in 4 and CPS in 10 cases. Shunt dependency occurred in 2 of 19 CPS (11%) and shunt revision was performed in 5(26%) CPS until the utility of programmable valves. Conclusion Subdural effusion or hematoma are probably supposed to have an underling IACs in children. Patients with raptured IACs can be treated conservatively in asymptomatic cases. As first procedure, burr hole and subdural drainage should be performed. Craniotomy or CPS should be reserved as the choice for special cases as alternative treatment. Programmable valves may contribute to decrease complications of CPS. Key words: Arachnoid cysts; Hematoma, subdural; Subdural effusion; Burr hole drainage; Cysto-peritoneal shunts