Treatment and prognosis of ruptured intracranial arachnoid cysts in children

ZHANG Gang; SHI Hangyu; MI Weiyang; SHI Yongqiang; LI Nan; JIANG Bin

Abstract：Objective The etiology,strategies and prognosis of subdural hematomas or hygroma caused by intracranial arachnoid cyst rupture in children were investigated.Methods Thirteen cases of subdural hematomas or hygroma caused by intracranial arachnoid cyst rupture in children in our hospital from September 2011 to December 2016 were analyzed retrospectively.There were 10 males and 3 females with a mean age of 5.1 years old (ranged 1.8 ～ 12.4 years).Results All the patients were followed up with a mean time of 22 months (3 ～ 40 months).The symptoms of intracranial hypertension disappeared in 13 cases.Imaging examination showed that hemorrhage or hygroma approximatively disappeared or was improved including 3 cases of disappearance,7 cases of cyst decrease and no changing in only 3 cases.For the cyst with the diameter ＜5 cm,the clinical prognosis was better than those whose diameter ＞ 5 cm.Conclusion The incidence of subdural hemotoma/effusion induced by intracraninal arachniod cysts rupture was low and the prognosis is good.The surgical treatment is applied to reduce the intracranial hypertension and burr hole evacuation is a preferred choice.Endoscope-assisted cyst-suprasellar cistern fistulation is suggested if evacuation is not satisfactory,but it could not reduce the incidence of hemorrhage.The 0size of cyst is associated with the prognosis.If pre-operative symptoms persist after the evacuation,additional surgery might be considered.The minimally invasive neuroendoscopic approach is safe in our hands and offers good symptom control,but successful treatment may not reduce the risk of haemorrhage post-traumatic head injury.Final outcome of IACs accompanied by subdural hematomas or hygroma may depend on the size of cysts.