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Risk Factors for Pediatric Arachnoid Cyst Rupture/Hemorrhage: A Case-Control Study

Cress, Marshall MD*; Kestle, John R.W. MD; Holubkov, Richard PhD§; Riva-Cambrin, Jay MD, MSc

doi: 10.1227/NEU.0b013e318285b3a4
Research-Human-Clinical Studies
Press Release

BACKGROUND: As the availability of imaging modalities has increased, the finding of arachnoid cysts has become common. Accurate patient counseling regarding physical activity or risk factors for cyst rupture or hemorrhage has been hampered by the lack of definitive association studies.

OBJECTIVE: This case-control study evaluated factors that are associated with arachnoid cyst rupture (intracystic hemorrhage, adjacent subdural hematoma, or adjacent subdural hygroma) in pediatric patients with previously asymptomatic arachnoid cysts.

METHODS: Patients with arachnoid cysts and intracystic hemorrhage, adjacent subdural hygroma, or adjacent subdural hematoma treated at a single institution from 2005 to 2010 were retrospectively identified. Two unruptured/nonhemorrhagic controls were matched to each case based on patient age, sex, anatomical cyst location, and side. Risk factors evaluated included arachnoid cyst size, recent history of head trauma, and altitude at residence.

RESULTS: The proportion of imaged arachnoid cysts that presented either originally or subsequently with a rupture or hemorrhage was 6.0%. Larger cyst size, as defined by maximal cyst diameter, was significantly associated with cyst rupture/hemorrhage (P < .001). When dichotomized with a 5-cm cutoff, 9/13 larger cysts ruptured and/or hemorrhaged, whereas only 5/29 smaller cysts ruptured/hemorrhaged (odds ratio = 16.5 (confidence interval [2.5, ∞]). A recent history of head trauma was also significantly associated with the outcome (P < .001; odds ratio = 25.1 (confidence interval [4.0, ∞]). Altitude was not associated with arachnoid cyst rupture or hemorrhage.

CONCLUSION: This case-control study suggests that larger arachnoid cyst size and recent head trauma are risk factors for symptomatic arachnoid cyst rupture/hemorrhage.

ABBREVIATION: CI, confidence interval

*Department of Neurosurgery, University of Missouri, Columbia, Missouri

Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah

§Division of Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah

Correspondence: Jay Riva-Cambrin, MD, MSc, Department of Neurosurgery, Division of Pediatric Neurosurgery, 100 N Mario Capecchi Dr, Salt Lake City, UT 84113. E-mail: Jay.Riva-Cambrin@hsc.utah.edu

Received June 21, 2012

Accepted December 18, 2012

Copyright © by the Congress of Neurological Surgeons