INTRACRANIAL ARACHNOID CYSTS: TREATMENT ALTERNA TIVES AND OUTCOME IN A SERIES OF 25 PATIENTS Zain Alabedeen B. Jamjoom, MD 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. Ann Saudi Med 1997: 17( 3 ):288-292. Arachnoid cysts are non-tumorous intra-arachnoid fluid colJections that account for about I st of all intracranial space-occupying lesions.' They may develop thoughout the cerebrospinal axis. with a predominance in the sylvian region. ~n' 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.~H 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 published in From the Di\ision of !\"eurosurgery. College of Medicine. King Saud Uni\'ersity. Ri:adh. Saudi Arabia. Address reprint requests and correspondence to Or. Jamjoom: Division of !\"eurosurgery. King Saud University. p.a, Box 2925. Riyadh 11-\61. Saudi Arabia, Accepted for publication n March 1997, Received 23 November 1996. 288 Annals of SOlidi />,fedicine, Vo117, No 3. 1997 the literature with the goal of determining the advantages and disadvantages of the various surgical approaches. Material and Methods The hospital records of 25 consecutive patients with intracranial arachnoid cysts who were treated in the Neurosurgical Units at King Khalid University Hospital (15 cases) and Security Forces Hospital (ten cases) between 1985 and 1995, were analyzed retrospectively. The diagnosis of arachnoid cyst was based on computerized tomography (CT) scan findings demonstrating a well-circumscribed and non-enhancing cystic lesion that had attenuation values similar to those of the cerebrospinal fluid (CSF) and did not communicate with the ventricular system."·1I There were 14 males and II females, ranging in age from a few days to 58 years, with an average of ten years. Nineteen (76st) patients were children below the age of 15 years. A summary of the presenting clinical symptoms and neurological status of the patients on aqmission are shown in Table I. In four patients, intracranial arachnoid cysts had already been suspected or detected in lItero during