Page 138 - AN-4-2

Advanced Neurology Management of subdural hygroma and intracranial ACs

asymptomatic patients, treatment options are controversial, fenestration should be considered for treatment to achieve
whereas symptomatic cysts can be managed through rapid relief of the patient’s symptoms.
expectant management, cyst shunting, or microsurgical/
endoscopic fenestration. The choice of the surgical method Acknowledgments
depends on the location of the cyst and its effect on nearby None.
structures. Better outcomes are seen with the endoscopic
33
treatment of suprasellar cysts; however, the efficacy of Funding
using endoscopy for middle fossa cysts is still debated. None.
Hall et al. found that endoscopic and microsurgical
34
methods yielded similar results. Shunting reduced the cyst Conflict of interest
volume more than other techniques, whereas endoscopic
fenestration led to shorter hospital stays. The location of The authors declare they have no competing interests.
the cyst plays a major role in the response to treatment, Author contributions
with midline and posterior fossa cysts showing the best
outcomes. Conservative management may be sufficient Conceptualization: Inas El Kacemi, Yao Christian Hugues
for asymptomatic middle fossa cysts with complications Dokponou, Abdessamad El Ouahabi
such as subdural hygroma and hematoma. Some studies Investigation: All authors
have indicated that symptomatic hygromas associated with Methodology: All authors
previously asymptomatic cysts can be managed without Writing – original draft: Inas El Kacemi, Yao Christian
surgery, and cyst diversion or fenestration may not be Hugues Dokponou, Rosina T. Gyamera
necessary for all patients in these cases. 35,36 Writing – review & editing: Inas El Kacemi, Yao Christian
Hugues Dokponou, Abdessamad El Ouahabi
The presented case has some important clinical findings.
First, the spontaneous rupture of the cyst into the subdural Ethics approval and consent to participate
space, without a history of head trauma, can be explained
by temporal bone thinning on the same side, which allows Informed consent of the patient was obtained before his
for energy transfer to the structures below. This may be due participation.
to a shared neurodevelopmental abnormality contributing Consent for publication
to the process. The thinned temporal bone is more likely
to accommodate the increase in intracranial pressure The patient gave verbal consent to publish his data in this
caused by the cyst, leading to gradual CSF accumulation study.
without immediate severe symptoms. Second, the absence
of hemorrhagic transformation in the present case Availability of data
indicates that the chronicity of the hygroma alone does Not applicable.
not necessarily lead to bleeding in children. Other factors
such as the expansion rate, head trauma, and venous References
compliance may play a more significant role in this process. 1. Tümtürk A, Durmuş NA, Görkem SB, Çiftçi M, Canpolat M,
The wide opening of the cyst into the subdural space likely Per H. Characteristic and management of pediatric
helps prevent bleeding by reducing the pressure gradient arachnoid cysts: A case series: Pediatric arachnoid cysts.
between different spaces in the brain. J Surg Med. 2022;6(8):756-761.
Despite the lack of immediate reduction in cyst size doi: 10.28982/josam.1028090
after surgery, the patient experienced complete symptom 2. Gosalakkal JA. Intracranial arachnoid cysts in children:
resolution without recurrence. This may be due to the A review of pathogenesis, clinical features, and management.
removal of any constraining effect on brain tissue, similar Pediatr Neurol. 2002;26(2):93-98.
to cardiac tamponade, allowing for better outcomes despite doi: 10.1016/S0887-8994(01)00329-0
the persistent presence of the cyst. The good outcomes
reported in other cases with expectant management of 3. Lim JW, Choi SW, Song SH, Kwon HJ, Koh HS, Youm JY. Is
similar conditions support this theory. 37-39 arachnoid cyst a static disease? A case report and literature
review. Childs Nerv Syst. 2019;35(2):385-388.
4. Conclusion doi: 10.1007/s00381-018-3962-z

In children, temporal ACs complicated with subdural 4. Mattei TA. Pediatric arachnoid cysts and subdural hygromas
hygroma are a rare comorbidity, and endoscopic in early infancy: Challenging the direction of the causality

Volume 4 Issue 2 (2025) 132 doi: 10.36922/an.3948