2017 Volume 40 Issue 1 Pages 54-59
We encountered two surgical cases of symptomatic middle cranial fossa arachnoid cysts and will report on the findings in these surgical cases with additional literature review.
Case 1 involved an 11-year-old boy who presented with an arachnoid cyst with chronic subdural hematoma on CT and MRI after mild head trauma due to soccer. He experienced headache, vomiting, and gait disturbance. Initially, he underwent surgical removal of the hematoma and microscopic fenestration of the cyst wall under general anesthesia, and he recovered. However, he needed re-operation because the subdural hematoma recurred. Re-operation involved membranectomy and coagulation of bridging veins running in the septum of the cyst, hematoma removal, and cyst fenestration. After re-operation, hematoma did not recur for >15 months.
Case 2 involved a 56-year-old man with an arachnoid cyst with subdural hygroma on CT and MRI after a mild head trauma due to falling. The patient reported disturbances in discrete movement of left upper limb. His initial surgical treatment included microscopic fenestration with membranectomy, the hygroma did not recur for >3 months.
Therefore, it is suggested that microscopic fenestration with membranectomy and coagulation of bridging veins around the cyst can reduce the postsurgical recurrence rate of symptomatic middle cranial fossa arachnoid cysts.
