Examination of intracranial arachnoid cysts in children, symptomatic or asymptomatic

Background: Arachnoid cysts (ACs) are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled cavities lined with arachnoid membranes. Most of them are found incidentally and are asymptomatic. The aim of this study was to describe the clinical and demographic characteristics of ACs and to investigate the frequency of complications. Methods: ACs were classified as cerebral and cerebellar, and were evaluated according to location and size using the Galassi classification. Results: Evaluation was made of 103 patients with AC admitted to the pediatric neurology department. The patients comprised 62.1% boys and 37.9% girls with a mean age of 10.1 ± 4.9 years. Headache was present in 33% of patients, epileptic seizures in 22.3%, and neuromotor developmental delay in 14%. Spontaneous intracranial hemorrhage (ICH) was observed in 6 patients (5.8%), with 3 (50%) having a cyst diameter ≥ 5 cm. ACs frequently involved the retrocerebellar and temporal lobes. Epilepsy was diagnosed in 26 patients (25.2%) and in only one of them, epileptic discharge and AC originated from the same region. The risk of bleeding was found to be higher in patients with cyst diameter ≥ 5 cm (P = 0.032). Conclusion: Although ACs are generally considered harmless, a cyst size ≥ 5 cm is important in terms of the risk of bleeding and should be followed up regularly. Although it has been reported in the literature that ACs may be associated with epilepsy, no significant correlation was found between seizure type and electroencephalography (EEG) recordings in this study.