Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literature review

Balestrino, Alberto; Piatelli, Gianluca; Consales, Alessandro; Cama, Armando; Rossi, Andrea; Pacetti, Mattia; Fiaschi, Pietro; Pavanello, Marco

doi:10.1007/s00381-020-04560-3

Cited by 30 publications

(38 citation statements)

References 55 publications

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“…It happens generally at an age between 2 and 9 months and shows a strong male bias. The same epidemiology is also found in post-meningitis subdural collections [51] and sylvian arachnoid cysts [33], suggesting precarious hydrodynamics in male infants.…”

Section: Pathophysiology and Nosologysupporting

confidence: 61%

“…Arachnoid cysts are often complicated with subdural CSF collections containing very little or no blood and are often disclosed because of skull-base scalloping visible on CT scanner. The location of arachnoid cysts producing subdural collections is the sylvian fissure or brain convexity; these cysts are rarely congenital but generally develop later in life [33].…”

Section: Fake News 6: Bleeding Is Caused By Structural Lesionsmentioning

confidence: 99%

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The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

2021

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Background The shaken baby syndrome (SBS) is a common cause of severe traumatic lesions in infants. Although well established for almost five decades, SBS and its diagnosis are becoming more and more aggressively challenged in courts. These challenges feed on the scientific debate and controversies regarding the pathophysiology and the differential diagnoses, scientific uncertainty being readily exploited by specialized barristers. Material and methodsIn the present review, we analyze the most common challenges to the concept of SBS and its diagnosis, as well as the scientific evidence available to counter these challenges, the differential diagnoses, and how SBS can be diagnosed with confidence. Results We found that the pathophysiology of SBS is well documented, with stereotyped descriptions by perpetrators, in good correlation with experimental studies and computer models. SBS is a well-defined clinico-pathological entity with a characteristic constellation of lesions; with a rigorous evaluation protocol, its diagnosis can be made rapidly and with excellent accuracy beyond a reasonable doubt. Conclusion It is important that medical experts master an extensive knowledge regarding the pathophysiology of the lesions of SBS, in particular infantile subdural hematomas, as well as other CSF-related conditions. This emphasizes the role that pediatric neurosurgeons should play in the clinical and medicolegal management of these patients.

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Section: Pathophysiology and Nosologysupporting

confidence: 61%

Section: Fake News 6: Bleeding Is Caused By Structural Lesionsmentioning

confidence: 99%

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

2021

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“…Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Discussion Arachnoid cysts become symptomatic when they grow in size or rupture (7). The most frequent presenting symptom associated with arachnoid cysts is headache (3).…”

Section: Therapeutic Interventionmentioning

confidence: 99%

“…Increased intracranial pressure and valsalva maneuver are other possible causes of cyst rupture and hygroma. The most common finding of arachnoid cyst rupture on imaging is a collection in the subdural space (7).…”

Section: Therapeutic Interventionmentioning

confidence: 99%

Öncesinde Asemptomatik Olan Subdural Higroma İle Seyreden Spontan Araknoid Kist Rüptürü: Olgu Sunumu

NALBANT

Altuntaş

2021

Anatolian Journal of Emergency Medicine

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Aim: Spontaneous rupture of an arachnoid cyst resulting in a subdural hygroma is an infrequent event. We report an adult patient who had no previous neuroimaging and had acute onset headache, dizziness, and nausea unrelated to trauma.Case: A 67-year-old male patient was brought to the emergency service complaints of sudden onset of dizziness, headache, and vomiting while working in the garden. He described ongoing nausea and headache localized to the frontal region. Brain CT imaging was planned for the patient whose nausea and dizziness worsened while his symptomatic treatment continued. In the brain CT, a large hypodense extracerebral collection was detected in the area starting from the middle fossa in the right cerebral hemisphere and extending to the convexity level in the frontoparietal region. The patient was consulted in the neurosurgery unit. Surgical intervention was not considered, and the patient was admitted to the neurosurgery service for treatment. Due to the asymptomatic course in the service follow-ups, he was discharged with outpatient clinic control recommendations.Conclusion: This case illustrates the importance of recognizing the possibility of spontaneous rupture of an arachnoid cyst. This phenomenon should be considered as a differential diagnosis in patients without head trauma. Although it is rare, being aware of such a case is helpful in preventing possible bad outcomes.

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“…4 Most ACs (60%-80%) are diagnosed in the pediatric population and have been found to have a higher prevalence in boys. 1,[5][6][7] Most ACs are asymptomatic and do not require intervention, but in selected cases, such as large ACs with mass effect, progressively enlarging ACs, or ruptured ACs, intervention may be needed. 5 Particularly in the case of an AC rupture, there is a risk of intracystic hemorrhage, subdural hematoma, or subdural hygroma, which can cause raised intracranial pressure (ICP) and lead to adverse neurological symptoms.…”

mentioning

confidence: 99%

Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases

Watson

McDonald

Steinbok

et al. 2022

Journal of Neurosurgery: Case Lessons

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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.

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Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literature review

Cited by 30 publications

References 55 publications

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

Öncesinde Asemptomatik Olan Subdural Higroma İle Seyreden Spontan Araknoid Kist Rüptürü: Olgu Sunumu

Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases

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