Surgical management of ruptured intracranial arachnoid cysts in young adults: the role of subduroperitoneal shunt placement

• Intracranial arachnoid cysts (IAC) are a common incidental finding on brain MRIs in adults. • While IAC rupture is rarely reported in adults, evidence on according management strategies is lacking. • There is no current data on the effectiveness of subduroperitoneal shunt placement without pressure valves in young adults. • Although surgery is generally deemed necessary for symptomatic cases, the optimal surgical approach remains debated. • For ruptured IACs in young adults, burr hole trepanation and SDP shunting without pressure valves appear to be safe and effective. Intracranial arachnoid cysts (IAC) are a common incidental finding on brain MRIs in adults. While IAC rupture, leading to severe intracranial hypertension, is well-documented in children, it is rarely reported in adults. As a result, there is limited guidance on managing ruptured IACs in young adults. In particular, there is no data on the benefits of subduroperitoneal (SDP) shunt placement without interposed pressure valves in young adult patients, a treatment often used in pediatric patients. We present two cases of young adult patients presenting with ruptured IAC with subsequent subdural hematoma/collection and consecutive neurological decline. Based on these sample clinical cases, we will discuss the above-mentioned management strategy and provide an overview of the current available literature. This case series demonstrates the successful management of ruptured IAC in young adults through drainage of subdural fluid collections via burr hole trepanation, combined with SDP shunt placement without interconnected pressure valves. While there is general consensus that surgery is necessary for symptomatic cases following IAC rupture, the optimal approach remains debated. We provide additional evidence that burr hole trepanation combined with SDP shunt placement without interconnected pressure valves, a method commonly used in children, is a safe treatment option for young adults with ruptured IAC.