Management strategies for arachnoid cysts presenting with subdural hygromas: Literature review

Arachnoid cysts (ACs) are identified in 1–2 % of the population through intracranial imaging. A possible complication of arachnoid cysts (ACs) is their rupture, which can lead to the development of a subdural hygroma (SDG). Currently, there is no consensus on management strategies for these patients. We present a comprehensive literature review of this topic. Our bibliographic database search (PubMed) identified 55 studies published between 1983 and 2023, encompassing data on 148 patients. The mean age was 12.3 years. Most patients were male (76.5 %). 71 patients had a history of trauma. The middle cranial fossa was the most common site for ACs ( n = 146), with 52.7 % occurring on the left side. According to Galassi classification, 35.6 % ( n = 52) were type 2 cysts. Most authors opted for operative management of symptomatic cases, typically involving hygroma evacuation and cyst fenestration into basal cisterns. Our review of the literature revealed that, the most prevalent surgical approach was craniotomy with microscopic cyst fenestration, which was performed in 29 cases. Conversely, burr holes with endoscopic cyst fenestration were utilized in 20 cases. A conservative follow-up strategy was adopted in 18 cases. The mean post-operative follow-up period was 2.5 years. Ruptured ACs complicated by SDGs are infrequently encountered in neurosurgical practice, complicating the development of standardized treatment protocols. Thus, management should be individualized.