뇌지주막하 낭종을 동반한 만성뇌경막하출혈의 치료 ; 지주막낭종의 방사선소견의 의의 : 증례보고

초록

PURPOSE : Arachnoid cyst(AC) is a relatively common congenital intracranial mass lesion that originated from abnormal development of meninges. AC often accompany with chronic subdural hematoma(CSDH). In case of coexisting with CSDH, AC is easily confused to hematoma which may need surgical procedure. The authors have experienced a case that AC with CSDH patient who were treated by burr hole drainage, and introduce the treatment option and radiologic findings which were mimic to intracystic hematoma of AC coexisting with CSDH MATERIALS AND METHODS : A 19 years old man came to our hospital with continuous headache for 2 months ago, and vomiting at 3 days ago. He was alert, and no focal neurologic deficit. Emergent brain computed tomography(CT) scan revealed CSDH in left side, and there are suspicious AC in the ipsilateral temporal lobe, which cannot be ruled out hematoma. We think this lesion is CSDH with hemorrhagic AC, however they showed similar signal in the MRI. Thus, burr hole drainage of CSDH was performed. RESULTS : On and after operation, he has been decreased the headache, and discharged without neurologic deficit at 8 day after operation. In immediate postoperative radiologic findings, inner component of AC changed to cerebrospinal fluid(CSF) density, and later being more like CSF in repeated exam. CONCLUSION : In some publications reporting AC with CSDH, the radiologic findings in the AC seems like hematoma is actually confirmed CSF in operative finding. A suggested hypothesis was characteristics of microscopic structure of CSDH membrane and arachnoid cyst. The breakdown products of CSDH was infiltrated into the AC seems to be a hematoma at radiologic evaluation. Either AC unfolding again after compression or penetration are both possible, however there is no report about relationship between both spaces. AC associated with chronic subdural hematoma is anatomically separated conditions which can be resolved with surgical drainage of t