Redo Aortic Surgery in a Patient with a Large Arachnoid Cyst and Myelodysplasia

Abstract

A 70-year-old man was referred for redo root and ascending aortic surgery. Preoperative investigations depicted a large arachnoid cyst occupying the left frontotemporal region and myelodysplasia with persistent thrombocytopenia. We describe successful operative management of this patient in the context of such rare intracranial pathology.

Keywords

aortic surgery - arachnoid cyst - reoperative surgery

We report on a 70-year-old man referred for redo surgery having originally undergone isolated bioprosthetic aortic valve replacement a decade prior for regurgitant bicuspid aortic valve disease. Investigations demonstrated severe eccentric aortic regurgitation secondary to structural valve deterioration, left ventricular dilatation with moderately impaired systolic function, dilated root, and ascending aorta at 4.8 and 4.5 cm, respectively ([Fig. 1]).

Fig. 1 Chest computed tomography coronal view showing dilated aortic root (4.8 cm, red arrow) and ascending aorta (4.5 cm, yellow arrow).

Comorbidities included myelodysplastic syndrome accompanied by a monoclonal gammopathy of undetermined significance with persistent thrombocytopenia. Cranial computed tomography scan depicted a large arachnoid cyst occupying the left frontotemporal region ([Fig. 2]).

Fig. 2 Cranial computed tomography axial (A) and coronal (B) views showing arachnoid cyst (arrows) occupying left frontotemporal region.

Reported prevalence estimates of arachnoid cysts are 0.3 to 1.7%.[1] Most feared complications of arachnoid cysts include intracystic or subdural hemorrhage associated with trauma, albeit spontaneous cases have been reported.[2]

Urgent neurosurgical consult was requested, in order to quantify the risks of bleeding and adverse neurological outcomes in the advent of redo aortic surgery and thrombocytopenia. In view of the chronic appearances of the arachnoid cyst in a neurologically asymptomatic patient, we were reassured to proceed with surgery. He underwent redo pericardial composite root and ascending aortic replacement under moderate hypothermic circulatory arrest. He made an uneventful recovery and remains well 24 months postoperatively.

Conflict of Interest

The authors declare no conflict of interest related to this article.

Acknowledgments

None.

• References

• 1 Al-Holou WN, Terman S, Kilburg C, Garton HJL, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in adults. J Neurosurg 2013; 118 (02) 222-231
• 2 Kaszuba MC, Tan LA, Moftakhar R, Kasliwal MK. Nontraumatic subdural hematoma and intracystic hemorrhage associated with a middle fossa arachnoid cyst. Asian J Neurosurg 2018; 13 (01) 116-118

Publication History

Received: 13 June 2022

Accepted: 07 April 2023

Article published online:
24 August 2023