Chronic Subdural Hematoma Associated with Arachnoid Cyst of the Middle Fossa: Surgical Treatment and Mid-Term Results in Fifteen Patients.

AIM

To report neurological and radiological features, surgical management, and mid-term outcomes of patients with chronic subdural hematoma (CSDH) associated with ipsilateral arachnoid cyst (AC) of the middle fossa.

MATERIAL AND METHODS

A total of 453 patients with CSDH were treated at our clinic between August 2004 and August 2012. Of these patients, 15 had ipsilateral AC in the middle fossa. A single burr hole craniostomy was performed to drain the hematoma. The AC was left intact in 14 patients, and one patient had no surgical intervention. The follow-up period ranged from 13 to 88 months (mean 43.07 ± 23.23 months).

RESULTS

The patients with AC associated CSDH were found to be younger than the patients with CSDH alone, and the mean age of 58 patients was 13.15 ± 13.17 years, while it was 11 ± 14.22 years in the other patients. Eleven patients had experienced head trauma at 21?50 days before admission. Hematoma evacuation through a single burr hole with closed-system subdural drainage performed at 2?4 days after surgery improved the symptoms in all patients. Two patients developed subdural fluid collection, which was treated by subduroperitoneal shunt placement.

CONCLUSION

Greater prevalence of ACs in patients with CSDHs has been reported in the literature. We recommend the drainage of the hematoma via a single craniostomy and to leave the AC intact as the first choice of treatment if the associated AC is a Galassi type I or II. Additional subduroperitoneal shunting may be performed in patients with Galassi type III cyst.