Rotura Espontânea de Quisto Aracnóide

Abstract

Arachnoid cysts are benign congenital cerebrospinal fluid collections, usually asymptomatic and diagnosed incidentally in children or adolescents. They may become symptomatic after enlargement or complications, frequently presenting with symptoms of intracranial hypertension. We report an unusual case of progressive refractory headache in an adult patient due to an arachnoid cyst spontaneous rupture. Although clinical improvement occurred with conservative treatment, the subdural hygroma progressively enlarged and surgical treatment was ultimately needed. Spontaneous rupture is a very rare complication of arachnoid cysts. Accumulation of cerebrospinal fluid accumulation in the subdural space causes sustained intracranial hypertension that may be life-threatening and frequently requires surgical treatment. Patients with arachnoid cysts must be informed on their small vulnerability to cyst rupture and be aware that a sudden and severe headache, especially if starting after minor trauma or a Valsalva manoeuvre, always requires medical evaluation.

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

“…The mechanism underlying arachnoid cyst rupture has not been definitively established. Two mechanisms have been proposed, however [ 3 6 8 9 ]. The first theory is that arachnoid cyst rupture is associated with the rupture of bridging veins or vessels in the cyst wall, owing to the easy transfer of pressure through the cyst [ 3 ].…”

“…There is no consensus on the optimal treatment of ruptured arachnoid cysts, which depends on the symptom pattern and cyst location. Observation is possible in most patients with no symptoms or mild symptoms because arachnoid cysts associated with subdural or epidural hematomas may also spontaneously resolve [ 7 8 9 12 13 ]. If arachnoid cysts do not resolve spontaneously, burr-hole subdural drainage, craniotomy and cyst fenestration, and endoscopic cyst fenestration are the neurosurgical options [ 9 10 ].…”

“…However, simple drainage of chronic subdural hematomas is not sufficient for some patients who experience hematoma recurrence (incidence, 8.2%) [ 3 7 ]. Craniotomy and cyst fenestration is another option for patients with a risk of recurrence; only 1.5% of those who undergo this procedure experience hematoma recurrence [ 7 8 ]. However, craniotomy and cyst fenestration is associated with relatively high rates of morbidity (10%–15%) and mortality (1%) [ 4 14 ].…”

“…Some symptomatic cysts require surgical intervention, however. Subdural hemorrhage removal through burr-hole trephination is widely performed and improved prognosis [ 3 7 8 ]. We retrospectively analyzed ruptured arachnoid cysts with or without hemorrhage and reviewed the relevant literature.…”