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Spontaneous disappearance of two asymptomatic arachnoid cysts in two different locations
1Ondokuzmayis University, Medical Faculty, Department of Neurosurgery, Samsun, Turkey. cengizcokluk@yahoo.com
Insights
Two children with asymptomatic arachnoid cysts experienced spontaneous resolution without surgery. This suggests non-surgical management may be viable for pediatric arachnoid cysts.
Area of Science:
- Pediatric Neurosurgery
- Neuroimaging
- Cerebrospinal Fluid Dynamics
Background:
- Arachnoid cysts are common, often asymptomatic, intracranial lesions.
- Traditional management for symptomatic or large cysts often involves surgical intervention.
- The natural history and spontaneous resolution patterns of pediatric arachnoid cysts require further investigation.
Observation:
- Two pediatric patients, a 10-year-old boy and a 1-year-old girl, presented with asymptomatic arachnoid cysts.
- The first patient had a cyst in the right sylvian fissure; the second had a right cerebral convexity cyst.
- Neither patient had a history of significant head or body trauma, engaging only in typical daily activities.
Findings:
- Both arachnoid cysts resolved spontaneously within two years of diagnosis.
- Resolution is hypothesized to occur via cyst rupture into cerebrospinal fluid spaces due to mechanical stress from activities like exertion, coughing, or sports.
- Changes in intracystic and pericystic pressure are proposed mechanisms facilitating spontaneous rupture.
Implications:
- Neurosurgical intervention may not be mandatory for all asymptomatic pediatric arachnoid cysts.
- Conservative management with close monitoring via neuroimaging (CT and MRI) is a potential alternative.
- These findings challenge the absolute indication for surgery in select pediatric arachnoid cyst cases.
Abstract:
We report two children with asymptomatic arachnoid cysts which resolved spontaneously without any surgical intervention and history of major head and body trauma. The first child was a 10-year-old boy with an arachnoid cyst in the right sylvian fissure. The second child was a 1-year-old girl with a right cerebral convexity arachnoid cyst. Both of them were asymptomatic. Arachnoid cysts spontaneously disappeared within 2 years following initial diagnosing. There was no major head and body trauma except usual home, school and sports activity. We speculated that the cysts ruptured into cerebrospinal fluid circulation by the mechanical effects of some forced activities to the brain tissue and cyst, such as excessive breathing, coughing and sport activities. These factors may change the balance between intracystic and pericystic pressure and facilitate the rupturing of the cyst into subdural, subarachnoid and intraventricular spaces. These cases demonstrate that neurosurgical intervention of asymptomatic arachnoid cysts is not absolutely indicated in the paediatric age group. Close follow up with computerized tomography (CT) and magnetic resonance imaging (MRI) is a treatment option in the patient with arachnoid cysts located in the middle cranial fossa and cerebral convexity.