Intracranial Arachnoid Cysts: Treatment Alternatives and Outcome in A Series of 25 Patients

Abstract

A series of 25 patients with intracranial arachnoid cysts is analyzed retrospectively. There were 14 males and 11 females ranging in age between a few days and 58 (mean 10) years. Seventy-six percent of patients were children below the age of 15 years. Most of the patients presented with symptoms and signs of long-standing raised intracranial pressure, while localizing signs were rather uncommon. The clinical manifestations were often mild relative to the large size of the cyst. Associated hydrocephalus was present in three patients: one with suprasellar cyst and two with posterior fossa cysts. Seven patients with mild symptoms and small cysts were treated conservatively, while the remaining 18 patients underwent surgical treatment. The initial surgical procedure consisted of craniotomy and fenestration of the cyst in three patients, and cystoperitoneal shunting in the other 15. Of the three patients who underwent craniotomy, one improved postoperatively, while the remaining two developed complications consisting of wound infection and postoperative epilepsy in one and permanent severe neurological deficit in the other. In contrast, six of the 15 cysts treated by shunting resolved completely, eight were smaller, and one remained unchanged. Radiological regression of the cyst after shunting was associated with various degrees of clinical improvement in 13 patients (87%). Two (13%) of 15 shunted patients developed complications in the early postoperative period, consisting of wound infection in one and early shunt failure in the other. Three patients (20%) with shunts had late complications during the follow-up period, consisting of recurrent shunt failure in the first, subdural hematoma in the second, and perforation of the peritoneal catheter into the hepatic bile ducts in the third. These findings, as well as recent data from the literature, suggest that in the management of intracranial arachnoid cysts, cystoperitoneal shunting was more effective and had fewer serious complications than craniotomy and cyst fenestration, and therefore, it is recommended as the treatment of first choice. Ann Saudi Med 1997; 17(3) Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1% of all intracranial space-occupying lesions.1 They may develop thoughout the cerebrospinal axis, with a predominance in the sylvian region.2,3 Because of their benign nature and slow expansion, arachnoid cysts may remain symptomatic or produce only subtle symptoms and signs. On the other hand, they sometimes give rise to focal neurological deficits, raised intracranial pressure, and/or epileptic seizures. The question of when these lesions should be operated upon is, therefore, not always easy to answer. Moreover, the choice of the most appropriate surgical approach is still debated. 2,[4][5][6][7][8] In the following report, the author describes the clinical and radiological findings in 25 patients with intracranial arachnoid cysts. In addition, the treatment results are analyzed and compared with those publish...

A suprasellar arachnoid cyst resulting from an intraventricular haemorrhage and showing complete resolution following endoscopic fenestration

“…Arachnoid cysts are frequently asymptomatic, but neurological symptoms can arise from compression of adjacent structures or from raised intracranial pressure secondary to obstructing CSF flow 1 3. Suprasellar arachnoid cysts occur in 9–15% of arachnoid cysts 1.…”

“…In general, arachnoid cysts are seen as developmental abnormalities, occurring during embryonic development where splitting or duplication of the primary arachnoid membrane leads to intra-arachnoid fluid collections 3. In addition, acquired cysts can occur secondary to trauma, haemorrhage and inflammation.…”

“…They have a prevalence of 0.16% in neonates and account for 1% of all paediatric intracranial space-occupying lesions 1 2. Their aetiology is thought to arise from an abnormality during embryology development, although other mechanisms have been reported 3. Treatment options include endoscopic fenestration, surgical drainage via craniotomy and treatment with shunt insertion.…”

An unusual case of subdural haematoma presenting to the accident and emergency department

“…8 Options include observation (with serial CT and MRI), cystoperitoneal shunts, cystoventricular shunts, ventriculoperitoneal shunting, endoscopic fenestration (still being explored), and craniotomy with resection of the cyst or fenestration of the cyst wall.…”

Acute respiratory failure as a manifestation of an arachnoid cyst

“…[12] Symptomatic arachnoid cysts present with seizures, mental retardation, cognitive function impairment, ataxia, unusual bobbing of the head in infants and progressive weakness of lower limbs in cases of spinal arachnoid cyst. [3–5] Chiari malformation, syringohydromyelia have also been associated with these cysts. [6–8] Suprasellar cysts may produce visual impairment, obstructive hydrocephalus and endocrinal dysfunction in the form of precocious puberty, amenorrhea, developmental delay and retarded skeletal growth.…”