[Phenomenon of subdural accumulations in children with arachnoid cysts of the Sylvian fissure].

Abstract

One of the complications of arachnoid cysts of the Sylvian fissure is subdural accumulations including hygromas or hematomas. The last ones follow spontaneous or traumatic cyst rupture. Subdural accumulations can occur after surgical treatment (cystocisternostomy).

Objective: To describe subdural accumulations in 2 children with arachnoid cysts of the Sylvian fissure; to review literature data on genesis of this phenomenon, prevention and treatment.

Material and methods: Two children with arachnoid cysts of the Sylvian fissure and subdural accumulations are presented. In the first case, subdural accumulations arose as a result of primary spontaneous cyst rupture, in the second case - after endoscopic cystocisternostomy.

Results: The first child had spontaneous arachnoid cyst rupture Galassi type 2 with subsequent chronic subdural left-sided hematoma in the frontal-temporal-parietal region. Symptoms regressed after microsurgical subdural cystocisternostomy. Follow-up MRI after discharge revealed no subdural accumulations and brain dislocation. The second child had arachnoid cyst of the left Sylvian fissure Galassi type 3. After endoscopic cystocisternostomy, MRI in the first year revealed clinically insignificant subdural accumulations recognized as chronic subdural hygroma, after another year - as chronic hematoma. MRI after 3 years demonstrated complete regression of subdural accumulations.

Conclusion: Microsurgery with creation of communication between subdural cavity, cyst and basal cisterns is preferable for spontaneous rupture of arachnoid cysts of the Sylvian fissure and tense subdural accumulations in children. Isolated drainage of subdural accumulations may be sufficient in some cases. Clinically not significant subdural CSF collections after endoscopic fenestration of Sylvian fissure arachnoid cysts in children are often and do not require surgical correction in the majority of cases.