Brain Tumor Res Treat.  2023 Jul;11(3):210-215. 10.14791/btrt.2023.0013.

Radiologic Follow-up of Ruptured Arachnoid Cysts With or Without Hemorrhage: Five Case Reports and a Review of the Literature

• Kim GE
• Park SJ
• Kim YJ
• Kim SK
• Jung TY

• KMID: 2545118
• DOI: http://doi.org/10.14791/btrt.2023.0013

Abstract

Arachnoid cysts are usually asymptomatic and discovered incidentally. However, cysts may occasionally rupture because of minor head trauma. We describe the radiologic follow-up of 5 patients with ruptured arachnoid cysts featuring spontaneous resolution, subdural hygroma formation, and cystic and subdural hemorrhage. From January 2004 through July 2020, 5 patients (1.3%) with ruptured arachnoid cysts were evaluated out of 388 patients with arachnoid cysts encountered at our institution at that time. The 5 patients were all male, and they ranged in age from 6–17 years (median, 12 years). The median duration of radiologic follow-up was 3.5 years (range, 2.3–10.1 years). All of the ruptured arachnoid cysts were overlying the temporal lobe with Galassi type II. The median cyst diameter was 4.9 cm (range, 4.4–8.9 cm). Four patients had a history of recent minor head trauma. There were no particular neurologic symptoms in their past medical history in all patients. In the follow-up, two patients’ cysts resolved spontaneously without hemorrhage. One patient’s cyst resolved post-burr-hole drainage for chronic subdural hemorrhage. Another patient, whose cyst led to a hemorrhage and chronic subdural hemorrhage, recovered following a craniotomy, hematoma removal, and cyst fenestration. Another patient, presenting with hygroma, cystic hemorrhage, and chronic subdural hemorrhage, was treated with burr-hole drainage. Three patients recovered postoperatively. Arachnoid cysts rarely rupture, and surgical intervention is required for some cases associated with hemorrhage. Postoperatively, all patients had good outcomes without complications in this series.

Keyword

Arachnoid cysts; Rupture; Hemorrhage; Subdural effusion

Figure

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  Fig. 1 Patient 2: radiologic follow-up of a ruptured arachnoid cyst with spontaneous resolution. A and B: 4.4 cm–diameter arachnoid cyst on the left temporal lobe on CT. C and D: Follow-up CT image showing a spontaneously resolved cyst and persistent temporal bone changes after 3.5 years.

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  Fig. 2 Patient 3: radiologic follow-up of a ruptured arachnoid cyst with a chronic subdural hematoma and spontaneous resolution of arachnoid cyst. A: T2-weighted magnetic resonance (MR) image showing a 4.9-cm–diameter arachnoid cyst on the left temporal lobe. B: T2-weighted MR image showing a chronic subdural hematoma in the left hemisphere. C: 1-Month follow-up CT image showing a temporal arachnoid cyst after aggravated symptoms. D: 1-Month follow-up CT image showing an enlarged chronic subdural hematoma with midline shift. E: 2-Year follow-up CT image showing that the arachnoid cyst had shrunk to a diameter of 2.5 cm. F: 2-Year follow-up CT image showing no chronic subdural hematoma.

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  Fig. 3 Patient 5: radiologic follow-up of a ruptured arachnoid cyst with subdural hygroma, cystic hemorrhage, and chronic subdural hematoma. A and B: CT image showing a 4.7-cm–diameter temporal arachnoid cyst. C: Temporal arachnoid cyst on 5.5-year follow-up CT. D: Bilateral subdural hygromas on 5.5-year follow-up CT. E: Arachnoid cyst with hemorrhage on 5.6-year follow-up CT. F: Chronic subdural hematoma on the left frontotemporal lobe on 5.6-year follow-up CT. G and H: Enlarged arachnoid cyst without any hemorrhage on 7.1-year follow-up CT.

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