Surgical Treatment of Intracranial Arachnoid Cyst.

Kim, Joe Young; Choi, Joong Uhn; Kim, Young Soo; Chung, Sang Sup; Lee, Kyu Chang

Original Article

Journal of Korean Neurosurgical Society 1981;10(2): 505-518.

Joe Young Kim, Joong Uhn Choi, Young Soo Kim, Sang Sup Chung, Kyu Chang Lee

Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

The authors operated 17 cases out of 28 intracranial arachnoid cysts experienced from July, 1972 to August, 1981. The clinical analysis and surgical experiences were summarized as follows. The supratentorial cysts were 67.9% and the infratentorial cysts were 32.1% of the intracranial arachnoid cysts. The predilection sites were middle cranial fossa of the supratentorial(60.7%) and the inferior midline of the infratentorial(17.9%). 2) The middle fossa arachnoid cysts were prominent in males under the age of 20. 3) The common complicating lesions in the supratentorial arachnoid cysts were chronic subdural hematoma(23.5%) and subdural hygroma(5.9%). Hydrocephalus was usually combined with the infratentorial arachnoid cyst(66.7%). 4) The most frequent symptom was headache(75%) with similar frequency in both supratentorial and infratentorial lesions. In the supratentorial cysts, headache was also complained with highest frequency even in cases without increased intracranial pressure(61.5%). The main clinical features of arachnoid cysts were headache, signs of increased intracranial pressure, other neurologic deficits and seizure in order of frequency. 5) Cranial deformities on the plain X-ray films were observed in 70.6% of middle fossa cysts. The brain CT scan provided a definite diagnostic information, while the cerebral angiography offered clues for differential diagnosis. 6) The authors selected the direct intracranial approach as a curative measure in most cases and the essential step in this procedure was thought to establish a communication between the cyst and the basal cistern or adjacent subarachnoid space. But in a few special cases such as deep-seated cysts or extensively large ones, a cystoperitoneal shunt was a more preferable procedure. The infratentorial cysts with hydrocephalus almost always required ventriculoperitoneal shunt in our cases. We considered it is very important to perform periodic follow-up brain CT scan to detect a recurrence of cyst or recollection of C.S.F., postoperative complications and persistent hydrocephalus.