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 II 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 conservativ'ely. 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 (879c). Two (1390) 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 (209c) 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.