Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases

Abstract

BACKGROUND Arachnoid cysts are benign, often asymptomatic intracranial mass lesions that, when ruptured, may cause seizures, raised intracranial pressure, hemorrhage, and/or loss of consciousness. There is no widely agreed upon treatment, and there is debate as to whether a nonoperative or surgical approach is the best course of action. The carbonic anhydrase inhibitor acetazolamide may be an effective nonoperative approach in treating ruptured arachnoid cysts. OBSERVATIONS The Pediatric Neurosurgery Clinical Database at BC Children’s Hospital from 2000 to 2020 was queried, and four pediatric patients who were treated with acetazolamide after presentation with a ruptured middle cranial fossa arachnoid cyst were identified. All patients showed some degree of symptom improvement. Three of the patients showed complete reabsorption of their subdural collections in the ensuing 6 months. One patient had an inadequate response to acetazolamide and required surgical management. LESSONS Acetazolamide is a safe and reasonable primary treatment option in pediatric patients with ruptured middle cranial fossa arachnoid cysts, and it may help avoid the need for surgery.

Letter: Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature and Case Report

“…3 Even in the presence of symptoms, medications such as acetazolamide have been shown to promote cSDH resorption in pediatric patients after arachnoid cyst rupture. 4 These reports indicate that MMA embolization should not be seen as the least invasive management option for all pediatric cSDH cases upfront. However, other etiologies such as trauma and spontaneous formation may be more amenable to MMA embolization as a lesser invasive, more permanent procedure compared with subdural taps, subdural drains, and burr hole evacuation options.…”