J Cerebrovasc Endovasc Neurosurg.  2013 Dec;15(4):311-315. 10.7461/jcen.2013.15.4.311.

Communicating Hydrocephalus Accompanied by Arachnoid Cyst in Aneurismal Subarachnoid Hemorrhage

Affiliations
  • 1Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea. redcheek09@naver.com

Abstract

The authors describe a case of communicating hydrocephalus accompanied by an arachnoid cyst in an aneurismal subarachnoid hemorrhage. A 69-year-old female was referred to our clinic due to the sudden onset of a headache. A head computed tomography scan demonstrated an arachnoid cyst in the right middle fossa with a mass effect and diffuse subarachnoid hemorrhage. Digital subtraction angiography then revealed a left internal carotid-posterior communicating artery aneurysm. The neck of the aneurysm was clipped successfully and the post-operative period was uneventful. However, two months after discharge, the patient reported that her mental status had declined over previous weeks. A cranial computed tomography scan revealed an interval increase in the size of the ventricle and arachnoid cyst causing a midline shift. Simultaneous navigation guided ventriculoperitoneal shunt and cystoperitoneal shunt placement resulted in remarkable radiological and clinical improvements.

Keyword

Arachnoid cyst; Cerebral aneurysm; Hydrocephalus; Shunt; Subarachnoid hemorrhage

MeSH Terms

Aged
Aneurysm
Angiography, Digital Subtraction
Arachnoid*
Arteries
Female
Head
Headache
Humans
Hydrocephalus*
Intracranial Aneurysm
Neck
Subarachnoid Hemorrhage*
Ventriculoperitoneal Shunt

Figure

  • Fig. 1 The initial computed tomography (CT) scan shows a large, hypodense lesion within the right middle cranial fossa, causing a midline shift with right lateral ventricle compression, and scanty subarachnoid hemorrhage in the left sylvian fissure.

  • Fig. 2 Left internal carotid angiogram depicting a left internal carotid-posterior communicating artery aneurysm projecting posteriorly and laterally.

  • Fig. 3 Postoperative CT scan showing decreased ventricle size.

  • Fig. 4 CT scan obtained two months after operation showing an interval increase in ventricle and arachnoid cyst sizes causing a midline shift.

  • Fig. 5 Lateral skull radiograph demonstrating 2 intracranial catheters in the cyst and lateral ventricle connected by a titanium Y-shaped connector (arrow) at the gate of the single valve.

  • Fig. 6 Follow-up CT scans obtained at about one year post-operatively show proper positioning of shunt components (A) and an interval decrease in ventricles and cyst sizes (B).


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