Kieu Hung Dinh, Le Tam Duc, Tran Trung Quang
Department of Surgery, HanSoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
Int J Surg Case Rep. 2021 Apr;81:105789. doi: 10.1016/j.ijscr.2021.105789. Epub 2021 Mar 17.
Spontaneous hemorrhage of the arachnoid cyst was rare, especially associated with chronic subdural hematoma (CSDH). In this paper, we reported successful surgical management of arachnoid cyst with spontaneous hemorrhage and associated subdural hematoma.
A 33-year-old female with no medical history was presented with a headache for one month prior to admission. Head computed tomography and magnetic resonance imaging showed a left hypodense middle cranial fossa arachnoid cyst and ipsilateral CSDH. The multiple-slice computed tomography with contrast showed no vascular abnormality. The patient was indicated for surgical hematoma evacuation, membranectomy, and fenestration of the arachnoid cyst. At the one postoperative month, the computed tomography showed a middle fossa arachnoid cyst with no hemorrhage. Until a postoperative year, the patient had no headache and no neurological deficits. She returned to daily activities and her work.
This event's pathogenesis was thought of as a result of tearing of the outer wall of an arachnoid cyst. The most common cause was mild head trauma; however, spontaneous rupture of the cyst wall also occurred. Surgery was the most common and effective treatment. Evacuation of CSDH was mandatory, but the strategies treatment for arachnoid cysts varied. Surgical options for arachnoid cyst included endoscopic/microsurgical fenestration, membranectomy, and even the cysto-peritoneal shunting.
Arachnoid cyst with spontaneous intracystic hemorrhage accompanying CSDH was an uncommon condition. Surgery was the most common and effective treatment. Besides evacuation of CSDH, endoscopic/microsurgical fenestration or membranectomy was recommended to prevent the recurrence.
蛛网膜囊肿自发性出血较为罕见，尤其是合并慢性硬膜下血肿（CSDH）时。在本文中，我们报告了对伴有自发性出血及相关硬膜下血肿的蛛网膜囊肿进行成功手术治疗的病例。
一名33岁无病史女性，入院前头痛1个月。头颅计算机断层扫描（CT）和磁共振成像（MRI）显示左侧中颅窝低密度蛛网膜囊肿及同侧CSDH。增强多层CT未显示血管异常。患者接受了手术血肿清除、囊肿壁切除术及蛛网膜囊肿开窗术。术后1个月，CT显示中颅窝蛛网膜囊肿无出血。至术后1年，患者无头痛及神经功能缺损。她恢复了日常活动和工作。
该事件的发病机制被认为是蛛网膜囊肿外壁撕裂所致。最常见的原因是轻度头部外伤；然而，囊肿壁也会发生自发性破裂。手术是最常见且有效的治疗方法。清除CSDH是必要的，但对蛛网膜囊肿的治疗策略各不相同。蛛网膜囊肿的手术选择包括内镜/显微手术开窗、囊肿壁切除术，甚至囊肿 - 腹腔分流术。
伴有CSDH的蛛网膜囊肿自发性囊内出血是一种罕见情况。手术是最常见且有效的治疗方法。除了清除CSDH外，建议采用内镜/显微手术开窗或囊肿壁切除术以预防复发。
