Ruptured intracranial arachnoid cysts in the subdural space: evaluation of subduro-peritoneal shunts in a pediatric population
- 31 August 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Child's Nervous System
- Vol. 36 (9), 2073-2078
- https://doi.org/10.1007/s00381-020-04538-1
Abstract
Purpose Rupture of arachnoid cysts (AC) in the subdural space after trauma may cause a subacute/chronic subdural hematoma or a hygroma. Treatment of this complication still remains controversial, and no consensual strategy is to date clearly proposed. In this study, the authors evaluated the clinical and radiological evolution of patients treated by a subduro-peritoneal shunt for symptomatic subdural collections complicating ruptured AC. Methods Medical records of the 10 patients treated at our institution between January 2005 and December 2018 for a subdural collection associated with an intracranial AC were reviewed. Subduro-peritoneal shunts consisted of low-pressure valves from 2005 to 2012 (6 cases) and medium-pressure valves after 2012 (4 cases). Results A benign head trauma was retrospectively found in the history of 8 patients. The mean time to diagnosis ranged from 15 days to 5 months. Symptoms resulted mainly from intracranial hypertension. Six patients had an ipsilateral hygroma to the AC, 2 patients had a bilateral hygroma predominantly to the AC side, and 2 patients presented an ipsilateral chronic subdural hematoma. Arachnoid cysts were classified as Galassi I in 5 cases and Galassi II in 5 cases. Patients with chronic subdural hematoma were given a medium-pressure valve. Patients with subdural hygroma received a low-pressure valve in 6 cases and a medium-pressure valve in 2 cases. There were no complications during surgical procedures. All patients were rapidly free of symptoms after surgery and were discharged from hospital 1 to 4 days postoperatively. The subdural collection completely disappeared in all cases. In the long term, only 2 patients with low-pressure valves underwent shunt removal without any consequences, while a second surgical procedure was necessary to treat recurrence of intracranial hypertension in the 4 remaining cases. All the medium-pressure valves were removed without problems. The size of the AC was reduced in 3 cases, remained stable in 4 cases, and increased in 3 cases. No patients experienced recurrence of subdural collection during follow-up. Conclusions Medium-pressure subduro-peritoneal shunts should be considered as part of the arsenal of surgical strategy in symptomatic ruptured AC in the subdural space. The procedure is simple with a very low morbidity, and it allows rapid improvement of symptoms. Although the shunt is located in the subdural space, we strongly recommend avoiding devices which may create an overdrainage and expose the patient to shunt dependency such as low-pressure shunts.This publication has 28 references indexed in Scilit:
- Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysisNeurosurgical Focus, 2016
- Sports participation with arachnoid cystsJournal of Neurosurgery: Pediatrics, 2016
- Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a ChildCase Reports in Emergency Medicine, 2016
- Children With Arachnoid Cysts Who Sustain Blunt Head Trauma: Injury Mechanisms and OutcomesAcademic Emergency Medicine, 2016
- Arachnoid Cysts With Subdural Hematoma or Intracystic Hemorrhage in ChildrenPediatric Emergency Care, 2014
- Risk Factors for Pediatric Arachnoid Cyst Rupture/HemorrhageNeurosurgery, 2013
- Prevalence and natural history of arachnoid cysts in childrenJournal of Neurosurgery: Pediatrics, 2010
- Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatmentJournal of Neurosurgery, 2009
- Dissapearance of arachnoid cyst after rupturing into subdural spaceActa Neurochirurgica, 2007
- Ultrastructure and Pathogenesis of Intracranial Arachnoid CystsJournal of Neuropathology and Experimental Neurology, 1981