[Surgical treatment of intracranial arachnoid cysts]

The results of surgical treatment in 21 cases of intracranial arachnoid cysts, mostly in adults, are reviewed. There were 19 supratentorial and 2 infratentorial cysts. In all but one supratentorial cyst cases epileptic seizures were the major clinical presentation. CT scan was helpful in the diagnosis in most cases. In 7 patients CT-cisternography was performed and in 3 cases a connection of cyst cavity to intracranial cerebrospinal fluid space was demonstrated. The cysts were treated surgically in different ways including craniotomy for fenestration of cyst wall, resection of cyst wall and neighbouring cerebral structures or cyst-peritoneal shunting. In some cases successive surgical treatment was necessary since the initial surgery proved to be unsuccessful. The authors believe that the best results were achieved by cyst removal with resection of cerebral structures being the source of epileptic discharges under intraoperative electrocorticographic control. The regression or diminished intensity of seizures can be achieved in this way. The fenestration of cyst alone leads to cyst recurrence. Cyst-peritoneal shunting usually did not lead to significant reduction of cyst size and delayed complications caused this kind of treatment to be uneffective. The significant number of infectious complications in all surgical treated cases of arachnoid cysts suggest the need for avoiding operation in asymptomatic or oligosymptomatic cases.