Intracranial Arachnoid Cysts; Clinical Features and Management of 20 Cases and Review of the Literature

Abstract

Background: The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cyst in our department. The study was carried out between April 1, 2000 and October 1, 2009 at the Neurosurgery Department, Gheam Hospital Mashhad University.

Materials and Methods: 20 patients with Arachnoid cyst underwent surgery between April 1, 2000 until October 1, 2009, consisting of 12 males and 8 females ranging in age 5 to 68 years (mean age 32.4 years). 12 patients underwent surgery and one patient underwent endoscopic fenestration, and cystoperitoneal shunting (medium pressure) was performed in 7 patients. All patients were followed for minimum of 6 months after surgery.

Results: During the study period, 20 patients were investigated. the cysts had strong predilection for the middle cranial fossa in 12 patients  (60%), supra sellar region in 1 patient (5%), the cerebral convexity in 1 patient (5%), posterior cranial fossa in 2 patient (10 %) , cerebellopontine angle in 3 patients (15%), quadrigeminal cisterns in 1 patient (5%). All of 20 cysts had clearly unilateral distribution, 12 (60 %) were located on the left side and 8 (40%) on the right side. The most common symptoms on presentation were epileptic seizures (46%), increased intracranial pressure (34%), visual impairment (5%), headache (10%), and cerebellar sign (5%).

Conclusion: Arachnoid cysts have a strong predilection for the middle cranial fossa that may be explained by a meningeal maldevelopment theory, we also conclude that the major indication for surgery in patients with arachnoid cyst is the presence of intractable seizures, increased intracranial pressure, and compression of neuronal tissues. Headache only is not a surgical indication.