Sayer Faisal T, Alanezi Abdulrahman Khalaf, Zaidan Salem Nabil
Department of Neurosurgery, Ibn Sina Hospital, Kuwait.
Surg Neurol Int. 2022 Apr 15;13:156. doi: 10.25259/SNI_100_2022. eCollection 2022.
Arachnoid cysts (ACs) are benign, congenital, fluid-filled collection between two layers of the arachnoid membrane accounting for about 1% of all the intracranial space occupying lesions. These lesions are usually asymptomatic and detected incidentally by magnetic resonance imaging (MRI) or computed tomography scan imaging (CT). However, these lesions can present as spontaneous chronic subdural hematoma (CSDH) causing neurological deficits that require neurosurgical intervention.
We report a case of CSDH associated with AC in a 14-year-old Kuwaiti boy who presented with a 2 weeks history of headache, which was worsening over the time. Brain CT scan demonstrated a left frontotemporal large CSDH in contact with an underlying temporal AC that appeared isodense to the CSF. The patient underwent an emergency surgery to evacuate the CSDH through a burr hole, while the AC was left intact. During the postoperative period, the patient showed good recovery in terms of neurological symptoms. Follow-up MRI showed stable size of the AC with no recurrence of the CSDH.
Literature's review was done to determine the best surgical approach in treating spontaneous CSDH associated with AC. Burr hole evacuation of CSDH with irrigation only, leaving the AC intact, is a successful surgical approach for treatment and was associated with good outcome.
蛛网膜囊肿（ACs）是良性的先天性病变，为蛛网膜两层之间充满液体的结构，约占所有颅内占位性病变的1%。这些病变通常无症状，多在磁共振成像（MRI）或计算机断层扫描成像（CT）检查时偶然发现。然而，这些病变可表现为自发性慢性硬膜下血肿（CSDH），导致神经功能缺损，需要神经外科干预。
我们报告一例14岁科威特男孩，其CSDH与AC相关。该男孩有2周头痛病史，且症状逐渐加重。脑部CT扫描显示左额颞部有一大的CSDH，与下方颞部的AC相邻，AC在脑脊液中呈等密度。患者接受了紧急手术，通过钻孔引流CSDH，而AC未处理。术后，患者神经症状恢复良好。随访MRI显示AC大小稳定，CSDH无复发。
通过文献回顾确定治疗与AC相关的自发性CSDH的最佳手术方法。仅通过钻孔冲洗引流CSDH，保留AC完整，是一种成功的手术治疗方法，且预后良好。
