Coexistence of intracranial dysraphic cyst and aneurysm: A qualitative systematic review and multiple management portraits

Background: The coexistence of intracranial aneurysms and dysraphic cysts is a rare manifestation. The response triggered by the cyst and its proinflammatory content could play a role in the rupture or growth of a neighboring aneurysm. Methods: We performed a systematic review according to the PRISMA guidelines searching PubMed, Medline, Google Scholar and Embase. Additionally, we report a case of one patient with both a dermoid cyst and an ipsilateral anterior cerebral artery aneurysm, illustrating a progressive formation of the vascular lesion during the follow-up of the cyst. Results: Out of 103 papers fulfilling the inclusion criteria for the systematic review, 79 articles were selected for eligibility. Finally, a total of 9 cases, including our own case, were considered for the review. We found that all aneurysms were in the anterior circulation and all cysts were supratentorial. The aneurysms or parent vessels were in proximity or in contact with the dysraphic lesion, presenting a strong adherence to its capsule. The 3 dermoids presented with cysts rupture and showed simultaneous or delayed subarachnoid aneurysmal hemorrhage. Two epidermoid cysts were diagnosed after aneurysm rupture, while the others due to focal mass effect, as in the case of the neurenteric cyst. Conclusions: Coexistence of intracranial aneurysm and disraphic cyst is a rare finding with multiple possible presentations. In managing patients harboring disraphic cyst, the presence of the aneurysm should be ruled out during the standard workup. A coexistence of these pathologies could affect their natural histories, and this could justify a more active management protocol.