Korean J Neurotrauma.  2019 Oct;15(2):170-175. 10.13004/kjnt.2019.15.e18.

Disappearance of Arachnoid Cyst after Burrhole Trephination: Case Series

• Kim DU
• Park HR
• Chang JC
• Park SQ
• Cho SJ
• Park HK

• KMID: 2461123
• DOI: http://doi.org/10.13004/kjnt.2019.15.e18

Abstract

We report 3 cases of arachnoid cysts (ACs) that completely disappeared after burr hole drainage, without cyst fenestration into the subarachnoid space or cystoperitoneal shunt. The first patient was a 21-year-old female with an AC of the right cerebral convexity, found incidentally. After endoscopic AC fenestration was performed, the patient complained of persistent headache. Two-month postoperative brain imaging revealed reaccumulated AC and associated multi-stage subdural hematoma. Burr hole drainage was performed to resolve the chronic subdural hematoma (CSDH). Three months later, brain computed tomography showed that the CSDH and the AC had disappeared. The second patient was an 11-year-old male who had a history of trauma 1 month prior to presentation at the clinic. Brain magnetic resonance imaging revealed an AC in the left sylvian fissure with CSDH. We performed burr hole drainage to treat the CSDH first. Subsequently, the AC as well as the CSDH disappeared. The third case was an AC of the right parietal convexity, found incidentally. Only burr hole drainage was performed, following which, the AC disappeared. This case series shows that an AC can disappear naturally after rupture into the subdural space by trauma or the burr hole procedure.

Keyword

Arachnoid cysts; Trephination; Chronic subdural hematoma

MeSH Terms

Arachnoid Cysts
Arachnoid*
Brain
Child
Drainage
Female
Headache
Hematoma, Subdural
Hematoma, Subdural, Chronic
Humans
Magnetic Resonance Imaging
Male
Neuroimaging
Rabeprazole
Rupture
Subarachnoid Space
Subdural Space
Trephining*
Young Adult

Figure

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  FIGURE 1 Illustration of case 1. (A) Preoperative CT scan showed an AC in the right middle cranial fossa, (B) Immediate postoperative CT scan showed that the size of AC was reduced. (C) Postoperative 2-months CT scan revealed the multi-stage subdural hematoma in the right fronto-temporo-parietal convexity with midline shifting to the left side, (D) After burrhole drainage, CSDH disappeared, but reaccumulation of AC was newly notified, and (E) Follow-up CT scan performed 3 months after burrhole drainage showed an absence of CSDH as well as a significant regression of the AC.CT: computed tomography, AC: arachnoid cyst, CSDH: chronid subdural hematoma.

• 

  FIGURE 2 Illustration of case 2. (A) Brain CT showed an AC in left sylvian fissure and accompanied CSDH with subfalcian herniation, (B) Postoperative CT scan revealed disappearance of CSDH and remaining AC with air density, (C) In the follow-up CT scan 18 months after burrhole drainage, the brain expanded and AC disappeared without further management, and (D) The AC as well as CSDH did not recur until 18 months after burrhole drainage for CSDH.CT: computed tomography, AC: arachnoid cyst, CSDH: chronid subdural hematoma.

• 

  FIGURE 3 Illustration of case 3. (A) Brain MRI revealed an AC of the right parietal convexity found incidentally, (B) Post-burrhole trephination CT scan. Catheter drainage was performed after dura incision (C) Postoperative 3 months CT scan showed complete disappearance of AC.MRI: magnetic resonance imaging, CT: computed tomography, AC, arachnoid cyst.

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