Clinical characteristics and treatment methods of arachnoid cysts combined with chronic subdural hematomas

Aim To investigate the clinical characteristics and optimal treatment methods for arachnoid cysts (ACs) combined with chronic subdural hematomas (CSDH). Material and methods From February 2008 to December 2024, 22 patients with ACs combined with CSDH were treated in the Department of Neurosurgery at the Affiliated Hospital of Nantong University. Among them, 15 patients underwent unilateral or bilateral burr hole drainage of the subdural hematoma, 2 patients underwent craniotomy for cyst excision and hematoma removal, and 5 patients underwent endoscopic cyst excision and subdural hematoma drainage. A retrospective analysis was conducted on the patients' clinical data and treatment outcomes. Results The 15 patients who underwent burr hole drainage were followed up for 0.5 to 2 years, with no recurrence of hematoma. One patient experienced intracystic rebleeding 5 days postoperatively, presenting with a small subdural hematoma that was absorbed during follow-up. In another case, postoperative examination revealed the disappearance of both the cyst and the hematoma, but the cyst recurred after 40 days; subsequent follow-up showed no enlargement of the cyst and no recurrence of the hematoma. All patients who underwent craniotomy or endoscopic cyst resection recovered completely. Conclusion Burr hole drainage is generally the preferred initial treatment for patients with ACs combined with CSDH. For patients experiencing a recurrence of the cyst or hematoma, repeat burr hole drainage or cyst-targeted surgery is not necessary, and follow-up observation is sufficient. However, for patients with symptomatic cysts prior to bleeding or those with repeated episodes of cyst hemorrhage, simultaneous cyst resection and hematoma removal is recommended.