Hematoma within the Outer Membrane of the Arachnoid Cyst Located in the Middle Fossa: A Mechanism of Development of Chronic Subdural Hematoma Associated with Arachnoid Cysts


It is well known that chronic subdural hematoma (CSDH) occasionally arises in patients harboring an arachnoid cyst (AC) located in the middle fossa. Although the pathogenesis of CSDH associated with ACs remains unknown, several possible mechanisms have been proposed. In many reported cases, the patients with ACs in the middle fossa would be symptomatic according to development of CSDH. A 9-year-old girl presenting with a headache, nausea, and diplopia was referred to our department. Magnetic resonance imaging showed an AC in the left-side middle fossa and ipsilateral CSDH with a remarkable mass effect. Irrigation of the CSDH, partial removal of the outer membrane of the AC and CSDH, and endoscopic cystocisternostomy were performed to relieve her symptoms. Postoperative clinical course was excellent. Histopathological examination of the outer membrane of the CSDH demonstrated an arachnoid cell layer and hemorrhage from the granulation inside the membrane, and collagen fibers outside the membrane. These findings strongly suggested that the membrane and the content of the CSDH were derived from the outer membrane of the AC, and the CSF including the hemorrhage within the membrane, respectively. Laceration and hemorrhage from granulation tissue within the outer membrane of the AC are considered as one of the developmental mechanisms of the CSDH associated with AC in the middle fossa.

Share and Cite:

Hayashi, Y. , Kita, D. , Kinoshita, M. and Hamada, J. (2014) Hematoma within the Outer Membrane of the Arachnoid Cyst Located in the Middle Fossa: A Mechanism of Development of Chronic Subdural Hematoma Associated with Arachnoid Cysts. Open Journal of Modern Neurosurgery, 4, 97-103. doi: 10.4236/ojmn.2014.42018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Auer, L.M., Gallhofer, B., Ladumer, G., et al. (2011) Diagnosis and Treatment of Middle Fossa Arachnoid Cysts and Subdural Hematomas. Journal of Neurosurgery, 54, 366-369.
[2] Bilginer, B., Onal, M.B., Oguz, K.K., et al. (2009) Arachnoid Cyst Associated with Subdural Hematoma: Report of Three Cases and Review of the Literature. Childs Nervous System, 25, 119-124. http://dx.doi.org/10.1007/s00381-008-0728-z
[3] Mori, K., Yamamoto, T., Horinaka, N., et al. (2002) Arachnoid Cyst Is a Risk Factor for Chronic Subdural Hematoma Injuveniles: Twelve Cases of Chronic Subdural Hematoma Associated with Arachnoid Cyst. Journal of Neurotrauma, 19, 1017-1027. http://dx.doi.org/10.1089/089771502760341938
[4] Kwak, Y.S., Hwang, S.K., Park, S.H., et al. (2013) Chronic Subdural Hematoma Associated with the Middle Fossa Arachnoid Cyst: Pathogenesis and Review of Its Management. Childs Nervous System, 29, 77-82. http://dx.doi.org/10.1007/s00381-012-1896-4
[5] Page, A., Paxon, R.M. and Mohan, D. (1997) A Reappraisal of the Relationship between Arachnoid Cysts of the Middle Fossa and Chronic Subdural Hematoma. Journal of Neurology, Neurosurgery and Psychiatry, 50, 1001-1007. http://dx.doi.org/10.1136/jnnp.50.8.1001
[6] Servadei, F., Vergni, G., Frattarelli, M., et al. (1993) Arachnoid Cyst of Middle Fossa and Ipsilateral Subdural Hematoma: Diagnostic and Therapeutic Implications in Three Cases. British Journal of Neurosurgery, 7, 249-253. http://dx.doi.org/10.3109/02688699309023806
[7] Wester, K. and Helland, C.A. (2009) How Often Do Chronic Extra-Cerebral Haematomas Occur in Patients with Intracranial Arachnoid Cysts? Journalof Neurology, Neurosurgery and Psychiatry, 79, 72-75. http://dx.doi.org/10.1136/jnnp.2007.117358
[8] Parsch, C.S., Krauss, J., Hoffmann, E., et al. (1997) Arachnoid Cysts Associated with Subdural Hematomas and Hygromas; Analysis of 16 Cases, Long-Term Follow-Up and Review of the Literature. Neurosurgery, 40, 483-490. http://dx.doi.org/10.1227/00006123-199703000-00010
[9] Pradilla, G. and Jallo, G. (2007) Arachnoid Cysts: Case Series and Review of the Literature. Neurosurgery Focus, 22, E7. http://dx.doi.org/10.3171/foc.2007.22.2.7
[10] Domenicucci, M., Russo, N., Giugni, E., et al. (2009) Relationship between Supratentorial Arachnoid Cyst and Chronic Subdural Hematoma: Neuroradiological Evidence and Surgical Treatment. Journal of Neurosurgery, 110, 1250-1255. http://dx.doi.org/10.3171/2008.4.17509
[11] LaCour, F., Trevor, R. and Carey, M. (1978) Arachnoid Cyst and Associated Subdural Hematoma. Observation on Conventional Roentgenographic and Computerized Tomographic Diagnosis. Archives of Neurology, 35, 84-89. http://dx.doi.org/10.1001/archneur.1978.00500260022004
[12] Lesoin, F., Phellemmes, P., Rosseaux, M., et al. (1983) Arachnoid Cysts and Head Injury. Acta Neurochirgica (Wien), 69, 43-51. http://dx.doi.org/10.1007/BF02055852
[13] Takahashi, M., Sengoku, Y., Nishioka, H., et al. (1995) Arachnoid Cyst with Hematoma in the Cyst Wall. Neurological Surgery (No Shinkei Geka), 23, 445-449.
[14] Weinberg, P.E. and Flom, R.A. (1973) Intracranial Subarachnoid Cyst. Radiology, 106, 329-333.
[15] Cappelen, J. and Unsgaard, G. (1986) Arachnoid Cysts of the Middle Cranial Fossa and Traumatic Complication. Childs Nervous System, 2, 225-227.
[16] Davidhoff, L.M. and Dyke, C.G. (1938) Relapsing Juvenile Chronic Subdural Hematoma: A Clinical and Roentgeno-graphic Study. Bull Neurology Instvestigation, NY, 7, 95-111.
[17] Lee, K.S., Bae, W.K., Doh, J.W., et al. (1998) Origin of Chronic Subdural Haematoma and Relation to Traumatic Subdural Lesions. Brain Injury, 12, 901-910. http://dx.doi.org/10.1080/026990598121972
[18] Haines, D.E., Harkey, H.L. and al-Mefty, O. (1993) The “Subdural” Space: A New Look at an Outdated Concept. Neurosurgery, 32, 111-120. http://dx.doi.org/10.1227/00006123-199301000-00017
[19] Nagahori, T., Nishijima, M. and Takaku, A. (1993) Histological Study of the Outer Membrane of Chronic Subdural Hematoma: Possible Mechanism for Expansion of Hematoma Cavity. Neurological Surgery (No Shinkei Geka), 21, 697-701.
[20] Czernicki, T., Marchel, A., Nowak, A., et al. (2005) Arachnoid Cysts of the Middle Cranial Fossa Presented as Subdural Hematoma. Neurologiai Neurochirugia Polska, 39, 328-334.

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.