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. 2023 Dec 25;6(26):CASE23544.
doi: 10.3171/CASE23544. Print 2023 Dec 25.

Chronic subdural hematoma associated with type II and type III Galassi arachnoid cysts: illustrative cases

Bac Thanh Nguyen  1 , Van Dinh Tran  1 , Jehan Bista  2 , Trung Van Trinh  1
Affiliations

Chronic subdural hematoma associated with type II and type III Galassi arachnoid cysts: illustrative cases

Bac Thanh Nguyen et al. J Neurosurg Case Lessons. .

Abstract

Background: Arachnoid cysts (ACs) are congenital abnormalities that can be located anywhere within the subarachnoid space along the cerebrospinal axis, although they are most often found on the left side in the temporal fossa and sylvian fissure. ACs comprise approximately 1% of all intracranial space-occupying lesions and are considered potential risk factors for subdural hematoma (SDH) in individuals of all age groups who have experienced traumatic brain injury. Although it is uncommon for an intracystic hemorrhage of an AC to occur without evidence of head trauma, it may be more common among children and young adults. Here, the authors present three cases of spontaneous AC intracystic hemorrhage with chronic SDH. Additionally, they provide a thorough review of the existing literature.

Observations: All three patients with AC were adolescent males. In all cases, AC was identified using the Galassi classification (type II or III) and associated with spontaneous intracystic hemorrhage and chronic SDH as seen on imaging.

Lessons: Spontaneous intracystic hemorrhage is a rare complication and occurs most commonly on the left side. Surgery is the definitive treatment, requiring either craniotomy or burr hole for hematoma evacuation and microsurgical fenestration to drain the cyst into the subarachnoid cisterns.

Keywords: arachnoid cyst; chronic subdural hematoma; spontaneous intracystic hemorrhage.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1
FIG. 1
Left: Preoperative axial head CT with contrast showing a left temporal Galassi type III AC and chronic left SDH. Right: Postoperative axial head CT without contrast demonstrating total resection of the AC and SDH.
FIG. 2
FIG. 2
Left: Preoperative axial head CT with contrast showing a left temporal Galassi type II AC with chronic left SDH. Right: Postoperative axial head CT without contrast demonstrating total resection of the AC and SDH.
FIG. 3
FIG. 3
Left: Preoperative axial head CT with contrast showing a left temporal Galassi type II AC w/associated left chronic SDH. Right: Postoperative axial head CT without contrast demonstrating total resection of the AC and chronic SDH.
See this image and copyright information in PMC

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