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Background: Arachnoid cysts (ACs) are benign, congenital, fluid-filled collection between two layers of the arachnoid membrane accounting for about 1% of all the intracranial space occupying lesions. These lesions are usually asymptomatic and detected incidentally by magnetic resonance imaging (MRI) or computed tomography scan imaging (CT). However, these lesions can present as spontaneous chronic subdural hematoma (CSDH) causing neurological deficits that require neurosurgical intervention., Case Description: We report a case of CSDH associated with AC in a 14-year-old Kuwaiti boy who presented with a 2 weeks history of headache, which was worsening over the time. Brain CT scan demonstrated a left frontotemporal large CSDH in contact with an underlying temporal AC that appeared isodense to the CSF. The patient underwent an emergency surgery to evacuate the CSDH through a burr hole, while the AC was left intact. During the postoperative period, the patient showed good recovery in terms of neurological symptoms. Follow-up MRI showed stable size of the AC with no recurrence of the CSDH., Conclusion: Literature's review was done to determine the best surgical approach in treating spontaneous CSDH associated with AC. Burr hole evacuation of CSDH with irrigation only, leaving the AC intact, is a successful surgical approach for treatment and was associated with good outcome., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Surgical Neurology International.)

Background: Despite the superb visualization offered by the endoscopic endonasal transsphenoidal approach, the resection rates of large and giant pituitary adenomas have remained much lower than those of smaller macroadenomas. Various tumor characteristics can influence the extent of resection (EOR) and have been variably reported. Additional understanding of these factors is mandatory to improve the results. We analyzed the radiological and intraoperative tumor characteristics influencing the EOR in a cohort of patients with large and giant pituitary macroadenomas undergoing endoscopic endonasal transsphenoidal excision under our care., Methods: Twenty-eight patients were included. Magnetic resonance images were retrospectively analyzed for pre- and postoperative tumor volumetric analysis; preoperative tumor volume calculation using the formula (A × B × C/2); preoperative radioanatomical characteristics, including tumor shape, radiological structure, contrast enhancement, and extension; and the EOR. Intraoperative data were retrieved and included., Results: The preoperative calculated tumor volume was 38.14 ± 23.02 cm 3 and the preoperative measured tumor volume was 50.345 ± 17.36 cm 3 . A statistically significant difference was found between the calculated and measured tumor volumes for the whole cohort and for tumors with a maximum diameter >3.9 cm. A statistically significant difference in the EOR was found at a volume threshold of 26.2 cm 3 . Large cysts, heterogeneous enhancement, Knosp grade ≤2, soft tumor consistency, and tumor hemorrhage were significantly associated with gross total resection., Conclusions: Volumetric analysis should replace 2-dimensional methods in determining the size of large and giant pituitary adenomas. Specific tumor characteristics were associated with the EOR and could help in predicting the EOR for these tumors., (Copyright © 2019 Elsevier Inc. All rights reserved.)