1
|
Stevens AR, Yakoub KM, Davies DJ, Belli A, O'Halloran PJ. Arachnoid Cysts in Athletes with Sports-Related Concussion: A Case Series and Literature Review. SPORTS MEDICINE - OPEN 2024; 10:93. [PMID: 39222159 PMCID: PMC11369129 DOI: 10.1186/s40798-024-00757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Arachnoid cysts (AC) are associated with a risk of rupture or haemorrhage following head impact and pose a potential predisposing factor for significant complications of sport-related concussion. Despite a recognised association between ACs and intracranial haemorrhage/cyst rupture, the risk profile of participating in contact sports with AC is not well defined. We report a retrospective case series of players presenting to the Birmingham Sports Concussion Clinic between 2017 and 2023 and underwent MRI head, with a comprehensive review of the prior literature. RESULTS 432 athletes underwent MRI of which 11 were identified to have AC (middle fossa n = 8; posterior fossa n = 2, intraventricular n = 1). Average maximal diameter was 4.1 ± 1.2 cm. 64% had a protracted recovery (≥ 3 months). 9% experienced an AC specific complication (cyst rupture, complete neurological recovery, maximal diameter 6.5 cm, Galassi II, 4 previous concussions). 91% of patients (mean maximal diameter 3.9 ± 1.0 cm) experienced no complications despite multiple previous accumulated sports-related concussions (mean 3.3, range 1-9). Case studies from the literature are summarised (n = 63), with 98% reporting complications, none of which resulted in adverse or unfavourable neurological outcomes. Across prospective and retrospective cohort studies, 1.5% had a structural injury, and (where outcome was reported) all had a favourable outcome. CONCLUSIONS AC is an incidental finding in athletes, with the majority in our cohort having sustained serial concussions without AC complication. The single complication within this cohort occurred in the largest AC, and AC size is proposed as a tentative factor associated with increased risk of contact sports participation. Complications of AC appear to be a rare occurrence. This case series and review has not identified evidence to suggest that participation in sports with AC is of significant risk, though individualised assessment and discussion of the potential risks of contact sports participation should be offered.
Collapse
Affiliation(s)
- Andrew R Stevens
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - Kamal M Yakoub
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - David J Davies
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Antonio Belli
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Philip J O'Halloran
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
- Royal College of Surgeons of Ireland, Dublin, Ireland
| |
Collapse
|
2
|
Xu J, Wang J, Liu T, Wang Y, Chen F, Yuan L, Zhai F, Ge M, Liang S. Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children. World Neurosurg 2023; 175:e73-e80. [PMID: 36907272 DOI: 10.1016/j.wneu.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to investigate factors that influence subdural haemorrhage (SDH) secondary to intracranial arachnoid cysts (IACs) in children. METHODS Data of children with unruptured IACs (IAC group) and those with SDH secondary to IACs (IAC-SDH group) were analyzed. Nine factors, sex, age, birth type (vaginal or caesarean), symptoms, side (left, right, or midline), location (temporal or nontemporal), image type (I, II, or III), volume, and maximal diameter, were selected. IACs were classified as types I, II, and III according to their morphological changes observed on computed tomography images. RESULTS There were 117 boys (74.5%) and 40 girls (25.5%); 144 (91.7%) patients comprised the IAC group and 13 (8.3%) comprised the IAC-SDH group. There were 85 (53.8%) IACs on the left side, 53 (33.5%) on the right side, 20 (12.7%) in the midline region, and 91 (58.0%) in the temporal region. The univariate analysis showed significant differences in age, birth type, symptoms, cyst location, cyst volume, and cyst maximal diameter (P < 0.05) between the 2 groups. Logistic regression using the synthetic minority oversampling technique model showed that image type III and birth type were independent factors that influenced SDH secondary to IACs (β0 = 4.143; β for image type = -3.979; β for birth type = -2.542) and that the representative area under the receiver-operating characteristic curve value was 0.948 (95% confidence interval, 0.898-0.997). CONCLUSIONS IACs are more common in boys than in girls. They can be divided into 3 groups according to their morphological changes on computed tomography images. Image type III and caesarean delivery were independent factors that influenced SDH secondary to IACs.
Collapse
Affiliation(s)
- Jinshan Xu
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Wang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tinghong Liu
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yangshuo Wang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liu Yuan
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Shuli Liang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Paro MR, Ollenschleger MD, Fayad MF, Bulsara KR, Stoltz P, Martin JE, Bookland MJ, Hersh DS. Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature and Case Report. Oper Neurosurg (Hagerstown) 2023; 24:3-10. [PMID: 36519875 DOI: 10.1227/ons.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Middle meningeal artery (MMA) embolization is becoming increasingly studied as a safe, effective treatment for chronic subdural hematoma (cSDH) in adults. Among pediatric patients, however, MMA embolization for cSDH has been rarely described, and the potential benefit of this approach for pediatric patients remains unknown. OBJECTIVE To systematically review the literature and identify cases of pediatric MMA embolization for cSDH. We also report our experience with pediatric MMA embolization. METHODS A systematic review of the literature was performed to identify cases of pediatric MMA embolization for cSDH. Inclusion criteria included English language availability and pediatric age defined as less than 18 years. A pediatric patient treated with MMA embolization was also identified at our institution. RESULTS Five cases of pediatric MMA embolization for cSDH were identified in the literature. Two were associated with arachnoid cysts, 2 with antiplatelet/anticoagulation therapy, and 1 with abusive head trauma. There were no adverse events, and all patients demonstrated clinical and radiological improvement on follow-up. At our institution, a previously healthy 8-year-old male was found to have a right-sided acute-on-chronic SDH during a headache evaluation. A diagnostic angiogram was performed to rule out a dural arteriovenous fistula, and right-sided MMA embolization was performed concurrently. Rapid clinical and radiological improvement was observed, with complete resolution by 6 months. CONCLUSION MMA embolization may represent a treatment option for pediatric patients with cSDH.
Collapse
Affiliation(s)
- Mitch R Paro
- UConn School of Medicine, Farmington, Connecticut, USA
| | | | - Mohamad F Fayad
- Hartford Hospital, Department of Radiology, Hartford, Connecticut, USA
| | - Ketan R Bulsara
- UConn School of Medicine, Farmington, Connecticut, USA.,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Petronella Stoltz
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - Jonathan E Martin
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - Markus J Bookland
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - David S Hersh
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| |
Collapse
|
4
|
Massimi L, Bianchi F, Benato A, Frassanito P, Tamburrini G. Ruptured Sylvian arachnoid cysts: an update on a real problem. Childs Nerv Syst 2023; 39:93-119. [PMID: 36169701 PMCID: PMC9968703 DOI: 10.1007/s00381-022-05685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe. No definite information is available on its occurrence or management. The goal of the present article is to provide an update on the epidemiological, etiological, and clinical aspects and the management of this peculiar clinical condition. METHODS A comprehensive review of the English literature of the last 40 years on this topic has been realized. Moreover, a personal series of children investigated and treated in the last 20 years is presented. These patients were managed as follows: (1) treatment of the subdural collection; (2) identification of candidates for surgical treatment of the residual cyst (brain MRI, perfusion brain MRI, prolonged invasive ICP monitoring (selected cases), EEG, neuropsychological tests); (3) surgical treatment of the cyst in the patients with pathological perfusion MRI and/or ICP measurement and/or clear neurophysiological and neuropsychological correlations. RESULTS A total of 446 patients (430 from the literature and 16 from the personal series), mainly children, adolescents, and young adults, have been analyzed leading to the following results: (1) SAC rupture is rare but not negligible (yearly risk of rupture: 0.04%; overall risk up to 10% in children affected by SCAs). Prophylactic surgery in asymptomatic cases is not advisable. (2) The mechanism of rupture is not known but an impact of SAC against the sphenoid wing and/or a direct injury on SAC through a thinned temporal bone, with possible laceration of the cyst wall vessels and/or tear of the bridging veins, can be hypothesized. A head injury is often not reported (may be misdiagnosed). (3) Subdural collection (hygroma > chronic hematoma) is the most common finding followed by intracystic bleeding, extradural hematoma, and other types of bleeding. Signs or symptoms of raised intracranial pressure are the most frequent ones. (4) The complication of the rupture is usually treated in emergency or in the acute period by burr hole or craniotomic evacuation of the subdural collection, although a conservative management is possible in some cases. Following the rupture, the majority of SACs are treated (70%), often at the same time of the complication, but no specific investigations are routinely performed to select candidates. According to our protocol, only 43.7% of SACs needed to be treated. CONCLUSIONS The "spontaneous" or posttraumatic rupture of SACs is a rare but potentially significant complication followed by a generally good outcome. The course of the cyst is independent from the outcome of the complication, consequently requiring specific investigations for individuating those lesions interfering with CSF dynamics and/or cerebral blood flow.
Collapse
Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy.
- Catholic University of the Sacred Heart, Rome, Italy.
| | - F Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - A Benato
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|