Intracerebral hematoma after endoscopic fenestration of an arachnoid cyst

Abstract

Rationale:An intracranial arachnoid cyst is a relatively common congenital benign lesion. A small number of patients present with neurological symptoms. Endoscopic fenestration has become a common treatment for arachnoid cysts in recent years, but intracerebral hematoma after surgery is rarely reported.Patient concerns:A 60-year-old woman with an arachnoid cyst in the left parietal and occipital lobes showed obvious progressive neurological deficits. She had weakness in her right limbs for 2 years and a sudden convulsion in her left limbs.Diagnosis:An arachnoid cyst in the left parietal and occipital lobes was detected on magnetic resonance imaging.Intervention:Endoscopic fenestration was performed for the cyst. However, she developed an intracerebral hematoma after surgery, which was detected by computed tomography. Due to the exacerbation of the patient's condition in the early stage after surgery, reoperation was performed to remove the hematoma.Outcomes:The patient was finally cured with no serious neurological deficits.Lessons:The rare complication of intracerebral hematoma after surgery for an arachnoid cyst can lead to a rapid deterioration in the patient's condition. More-adequate preoperative examination and neuronavigation should be conducted during surgery. Appropriate enlargement of the bone hole may help protect against this complication. Moreover, prompt reoperation for the intracerebral hematoma may improve the prognosis.

Endoscopic Fenestration of an Intra-ventricular Arachnoid Cyst in a Young Male – A Rare Entity

“…It has limitations as in the case of large cysts there is difficulty in delimiting these and, in the case of vascular lesions, the loss of clear vision. 16 In neuro-endoscopy, imaging techniques are used to identify an area adjoining the cystic wall and ventricular ependyma. This in-between area is used to drain the cyst.…”

Asymptomatic intraventricular arachnoid cyst: a case report

“…Los procedimientos quirúrgicos principales son la cirugía de derivación, craneotomía y la fenestración neuroendoscópica. La primera, a pesar de ser simple, presenta como complicaciones la infección, el bloqueo de la derivación, una presión intracraneal baja y hemorragia intracraneal; la segunda, comprende una incisión de mayor extensión y los riesgos que conlleva una cirugía mayor; la tercera, es la menos invasiva y, por lo tanto, cursa con complicaciones de menor gravedad, pero como factores limitantes se encuentran los quistes de gran tamaño (por la dificultad para delimitarlos) y, en caso de lesiones vasculares, la pérdida de una visión clara (10).…”

“…Sin embargo, para los pacientes que cursen solo con dolor de cabeza, sin hidrocefalia secundaria o un aumento evidente de la presión intracraneal, el beneficio de la cirugía es incierto (10). Por lo tanto, en estos pacientes se recomienda la observación con o sin repetición de las imágenes, tal como se indicó en el caso (8).…”

Primary arachnoid cyst - an early postoperative complication after microsurgical resection

“…4 Figure 1 CT classification of Sylvian fissure arachnoid cysts 5 Slika 1. CT klasifikacija arahnoidnih cisti Silvijeve fisure 5 Controversy still exists about the best treatment modality for intracranial AC. There are 3 major surgical methods: craniotomy (opening or micro resection) with marsupialization into the subarachnoid spaces, basal cisterns or ventricles; neuro endoscopic fenestration or stereotactic aspiration and shunt surgery (cystoperitoneal, cystosubdural or ventriculoperitoneal).…”

“…There are 3 major surgical methods: craniotomy (opening or micro resection) with marsupialization into the subarachnoid spaces, basal cisterns or ventricles; neuro endoscopic fenestration or stereotactic aspiration and shunt surgery (cystoperitoneal, cystosubdural or ventriculoperitoneal). 5 The qualities of each are still a matter of debate. Table 1 shows data from the largest surgical series published in the past 10 years.…”