Intracranial arachnoid cysts

Abstract

Intracranial arachnoid cysts, known as leptomeningeal cysts, are benign lesions that develop after the collections of cerebral spinal fluid (CSF) wrapped by a wall of collagen and arachnoid cells congenitally (real) or acquired (sourced by bleeding, tumor, trauma, or meningitis). Most of these cysts are asymptomatic. Symptomatic cysts are detected in the first 20 years of life, and three-quarters of these cysts become symptomatic during childhood. Typical symptoms are headache, nausea, vomiting, epilepsy, sudden loss of consciousness depending on cyst rupture or bleeding, macrocephaly, hydrocephalus, endocrinological disorders, psychiatric disorders, and focal findings of the lesion occupying space within the head (weakness, cranial neuropathy). They are usually diagnosed using radiological imaging methods including X-Ray, transfontanel ultrasonography, computed tomography, magnetic resonance imaging, and scintigraphy. Surgical treatment is not recommended for arachnoid cysts unless they cause a mass effect or symptoms and they are annually follow-up with CT or MR scan is an appropriate method in asymptomatic patients. Interestingly, no standard surgical intervention method has been recommended for the cyst. Therefore, the patient's clinical and radiological findings, age, size, and localization of the cyst are still the most important factors in the decision-making of the surgical intervention method. Surgical intervention methods include cyst resection and fenestration of the cyst into the basal cisterns by craniotomy; endoscope-assisted cyst fenestration through the burr hole; cystoperitoneal shunt or ventriculoperitoneal shunt.