Ruptured Sylvian arachnoid cysts: an update on a real problem

Area of Science:

• Neurosurgery
• Neurology
• Pediatric Neurosurgery

Background:

• Sylvian arachnoid cysts (SACs) are the most common arachnoid cysts and are prone to rupture.
• Rupture of SACs is a rare but potentially severe event with limited information on occurrence and management.

Purpose of the Study:

• To update knowledge on the epidemiology, etiology, clinical presentation, and management of Sylvian arachnoid cyst rupture.
• To provide insights into the diagnosis and treatment strategies for this rare condition.

Main Methods:

• Comprehensive literature review of English articles from the last 40 years.
• Analysis of a personal series of 16 pediatric patients treated over the last 20 years.
• Management included treatment of subdural collections and surgical consideration for residual cysts based on MRI, ICP monitoring, EEG, and neuropsychological tests.

Main Results:

• Analyzed 446 patients (430 from literature, 16 personal series), predominantly children and young adults.
• SAC rupture risk is low (0.04% yearly, up to 10% in affected children), and prophylactic surgery for asymptomatic cases is not recommended.
• Subdural collections are common, with raised intracranial pressure being the most frequent symptom. Treatment of the rupture often involves evacuation of collections, with selective surgical treatment for residual cysts guided by specific investigations.

Conclusions:

• Rupture of Sylvian arachnoid cysts is rare but significant, typically with a good outcome.
• The cyst's long-term course is independent of the rupture complication, necessitating investigations to identify cysts affecting CSF dynamics or cerebral blood flow.