Pediatric Arachnoid Cysts: A Comprehensive Systematic Review of Clinical Features and Therapeutic Approaches

Background/Objectives: Subarachnoid cysts in children, while often linked to trauma, can also rupture spontaneously without any apparent injury. Their etiology remains complex, involving congenital, traumatic, and infectious factors. This article explores the risks, pathophysiology, and management strategies related to spontaneous rupture in pediatric cases reported in the literature through the means of a systematic review. Materials and Methods: A systematic review of Web of Science, Scopus, PubMed and the Virtual Health Library (BVS, for its acronym in Spanish) was conducted; the online software Ryyan was used to manage the references and conduct the filtering process. The National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool was used to assess bias for each type of study. Results: We analyzed the data of 101 articles; in total we found that 331 pediatric patients with arachnoid cyst were diagnosed with intracranial hemorrhage and 1030 patients had an unruptured arachnoid cyst. The most common cyst diameter was between 5-7 cm in the bleeding group vs. 3-4.5 cm in the non-bleeding group. A head trauma trigger was identified in 36.25% of cases of bleeding and 10.6% were sports related. Most of the hemorrhages were subdural, followed by a mixed pattern between subdural and intracystic. In both groups the arachnoid cyst was mostly located in the middle cranial fossa in the left side. The bleeding arachnoid cysts were mostly treated with surgery, but conservative treatment was also effective; the outcome was good in the majority of cases. Conclusions: Further research is required to elucidate the pathophysiological mechanisms underlying hemorrhage associated with arachnoid cysts in the pediatric population. Nevertheless, upon identification of an arachnoid cyst, neurosurgical follow-up is warranted. Bleeding tends to occur only in the presence of high-risk features and can be precipitated by traumatic events.