Skip to main content
SpringerLink
Log in

Arachnoid cysts: How do postsurgical cyst size and seizure outcome correlate?

  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Arachnoid cysts (ACs) are congenital cystic brain malformations associated with epilepsy. The purpose of this study was to determine the effect of surgical intervention of ACs on cyst size and seizure outcome.

We reviewed the world's medical literature dealing with surgically treated ACs in epilepsy patients. Our study included only cases, in which the relationship between pre- and post-operative CT-size of the AC and seizure outcome was described. We also included six patients with ACs and epilepsy treated surgically at the University of Mainz. We analyzed postoperative AC size and seizure outcome with respect to mode of operation, cyst location, and patients' age.

A total of 76 patients was reviewed. Sixty (79 %) patients had a smaller AC postoperatively. Forty-six of those 60 (76.6 % ) experienced seizure improvement. Thirteen patients (21.6 %) remained unchanged and one patient (1.8 %) worsened. In 16 of the 76 patients (21 %) the postoperative AC size was unchanged. Eight of those 16 patients improved. Six patients (37.5 %) remained unchanged and two (12.5 %) worsened. A positive correlation between postoperative AC size and seizure outcome was well demonstrated among patients treated by cyst fenestration, needle aspiration, orinternal shunting. Among patients treated by cystoperitoneal shunting this direct correlation was less clear.

Seizure outcome correlates directly with postoperative AC size. Seizure reduction is associated with decreased AC size postoperatively and depends on the mode of operation. Based on these data we would expect that patients with epilepsy secondary to ACs would demonstrate improved seizure control with lower AC volume. Conversely, we might expect increasing AC size to correlate with worse seizure control. This relationship may guide physicians in efficacy and timely patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams JH, LW Duchen (eds): Malformations of the nervous system. Arachnoid cysts. In: Greenfield's Neuropathology, 5th ed., Edward Arnold Publications, London, 1992.

  2. Aicardi J, F Bauman: Supratentorial extracerebral cysts in infants and children. J Neurol Neurosurg Psych 38 (1975) 57–68

    Google Scholar 

  3. Anderson FM, HD Segall, WC Caton: Use of computerized tomography scanning in supratentorial arachnoid cysts. J Neurosurg 50 (1979): 333–338

    Google Scholar 

  4. Artico M, L Cervoni, M Salvati: Supratentorial arachnoid cysts: clinical and therapeutic remarks on 46 cases. Acta Neurochirurgica 132 (1995) 75–78

    Google Scholar 

  5. Auer LM, B Gallhofer, G Ladurner: Diagnosis and treatment of middle fossa arachnoid cysts and subdural hematomas. J Neurosurg 54 (1981) 366–69

    Google Scholar 

  6. Becker T, M Wagner, E Hoffman: Do arachnoid cysts grow? A retrospective CT volumetric study. Neuroradiology 33 (1991) 341–45

    Google Scholar 

  7. Behrens P, CB Ostertag: Zystische Fehlbildungen des Gehirns: stereotaktische Diagnostik und Therapie. (German) Nervenarzt 63 (1992) 725–30

    Google Scholar 

  8. Beltramello A, C Mazza: Spontaneous disappearance of a large middle fossa arachnoid cyst. Surg Neurol 24 (1985) 181–83

    Google Scholar 

  9. Bhandari YS: Non-communicating supratentorial subarachnoid cysts. J Neurol Neurosurg Psych 35 (1972) 763–70

    Google Scholar 

  10. Bidzinski J, A Koziarski: Surgical treatment of intracranial arachnoid cysts. (Polish) Neurologia i Neurochirurgia Polska 23 (1989) 322–33

    Google Scholar 

  11. Bright R: Diseases of the brain and nervous system, Part I. Reports of medical cases selected with a view of illustrating the symptoms and cure of diseases by a reference to morbid anatomy, vol. 12; Longman, Rees, Orme, Brown, Green, Paternoster-Row and Highley; London 1831

    Google Scholar 

  12. Caemert J, J Abdullah, L Calliauw: Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 119 (1992) 68–73

    Google Scholar 

  13. Caldarelli M, C di Rocco: Surgical options in the treatment of interhemispheric arachnoid cysts. Surg Neurol 46 (1996) 212–21

    Google Scholar 

  14. Cascino GD: Epilepsy and brain tumors: Implications for treatment. Epilepsia 31 (suppl 3), 1990 337–344

    Google Scholar 

  15. Cascino GD, P Boon, DR Fish: Surgically remediable lesional syndromes. In:Engel J Jr. (ed): Surgical treatment of the epilepsies, 2nd ed. Raven Press, New York, 1993

    Google Scholar 

  16. Circillo SF, PH Cogen, GR Harsh: Intracranial arachnoid cysts in children: a comparison of the effects of fenestration and shunting. J Neurosurg 74 (1991) 230–35

    Google Scholar 

  17. Cullis PA, J Gilroy: Arachnoid cysts with rupture into the subdural space. J Neurol Neurosurg Psych 46 (1983) 454–56

    Google Scholar 

  18. Dott NM, FJ Gillingham: Mechanical aspects of the cerebrospinal fluid circulation. In: Wolstenholme HW, CM O'Connor (eds). The cerebrospinal fluid. Ciba Foundation Symposium Little Brown and Co. Boston, 1958

    Google Scholar 

  19. Dowd CF, WP Dillon, NM Barbaro: Magnetic resonance imaging of intractable complex partial seizures: Pathological and electroencephalographic correlation. Epilepsia 32 (1991) 454–59

    Google Scholar 

  20. Drake J, HJ Hoffman, J Kobayashi: Surgical management of children with temporal lobe epilepsy and mass lesions. Neurosurgery 21 (1987) 792–97.

    Google Scholar 

  21. Dyck P, P Gruskin: Supratentorial arachnoid cysts in adults. Arch Neurol 34: (1977) 276–79

    Google Scholar 

  22. Engel J: Recent advances in surgical treatment of temporal lobe epilepsy. Acta Neurol Scand 86 (suppl 140) 1992 71–80

    Google Scholar 

  23. Galassi E, G Gaist, G Giuliani: Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically Acta Neurochirurgica 42 (Suppl) 1988 201–204

    Google Scholar 

  24. Garcia-Bach M, F Isamat, F Vila: Intracranial arachnoid cysts in adults. Acta Neurochirurgica 42 (Suppl) 1988 205–209

    Google Scholar 

  25. Geissinger JD, WC Kohler, BW Robinson: Arachnoid cysts of the middle cranial fossa: surgical considerations. Surg Neurol 10 (1978) 27–33

    Google Scholar 

  26. Ghatak NR, GJ Mushrusk: Supratentorial intraarachnoid cyst. Case report. J Neurosurg 35 (1971) 477–82

    Google Scholar 

  27. Giroud M, JL Sautreaux, A Thierry, R Dumas: Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant. Childs Nerv Syst 4 (1988) 252–254

    Google Scholar 

  28. Go KG, HJ Houthoff, EH Blaauw: Arachnoid cysts of the Sylvian fissure. Evidence of fluid secretion. J Neurosurg 60 (1984) 803–813

    Google Scholar 

  29. Harsh IV GR, MSB Edwards, CB Wilson: Intracranial arachnoid cysts in children. J Neurosurg 64 (1986) 835–842

    Google Scholar 

  30. Hirsch JF, C Sainte-Rose, A Pierre-Kahn, A Pfister, E Hoppe-Hirsch: Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children. J Neurosurg 70 (1989) 568–572

    Google Scholar 

  31. Inoue T, T Matsushima, S Tashima: Spontaneous disappearance of a middle fossa arachnoid cysts associated with subdural hematoma. Surg Neurol 28 (1987) 447–450

    Google Scholar 

  32. Jelsma F, PJ Ross: Traumatic intracranial arachnoid cyst involving the Gasserian ganglion. Case report. J Neurosurg 26 (1967) 439–441

    Google Scholar 

  33. Kaplan BJ, JP Mickle, R Parkhurst: Cystoperitoneal shunting for congenital arachnoid cysts. Child's Brain 11 (1984) 304–11

    Google Scholar 

  34. Koch, CA D Voth, G Kraemer, M Schwarz: Arachnoid cysts: does surgery improve epileptic seizures and headaches? Neurosurg Rev 18 (3) (1995) 173–181

    Google Scholar 

  35. Koch CA, JL Moore, JA Robyn: Intracranial arachnoid cysts. Hospital Physician (1997) 52–59

  36. Lange M, R Oeckler: Results of surgical treatment in patients with arachnoid cysts. Acta Neurochir (Wien) 87 (1987) 99–104

    Google Scholar 

  37. Little JR, MR Gomex, CS Maccarty: Infrantentorial arachnoid cysts. J Neurosurg 9: (1973) 380–386

    Google Scholar 

  38. Locatelli D, N Bonfanti, R Sfogliarini: Arachnoid cysts: diagnosis and treatment. Childs Nerv Syst 3 (1987) 121–124

    Google Scholar 

  39. Lodrini SG, M Lasio, F Fornari: Treatment of supratentorial primary arachnoid cysts. Acta Neurochir (Wien) 76 (1985) 105–110

    Google Scholar 

  40. Loders HO (ed): Epilepsysurgery, Raven Press, New York 1992

    Google Scholar 

  41. Meencke HJ, D Janz: Neuropathological findings in primary generalized epilepsy: a study of eight cases. Epilepsia 25 (1984) 8–21

    Google Scholar 

  42. Mokri B, OW Houser, RP Dinapoli: Spontaneous resolution of arachnoid cysts. J Neuroimaging 4 (1994) 165–8

    Google Scholar 

  43. Moraci A, R Mignini, L Agozzino: Intracranial arachnoid cysts: aetiopathogenetical, morphological and surgical considerations. Acta Neurologica 37 (1982) 440–454

    Google Scholar 

  44. Mori T, M Fujimoto, K Sakae: Disappearance of arachnoid cysts after head injury. Neurosurgery 36 (1995) 938–41

    Google Scholar 

  45. Oberbauer RW, J Haase, R Pucher: Arachnoid cysts in children: a European cooperative study. Childs Nerv Syst 8 (1992) 281–6

    Google Scholar 

  46. Passero S, G Filosomi, R Cioni: Arachnoid cysts of the middle cranial fossa: a clinical, radiological and follow-up study. Acta Neurol Scand 82 (1990) 94–100

    Google Scholar 

  47. Punzo A, R Conforti, D Martiniello: Surgical indications for intracranial arachnoid cysts. Neurochirurgia 35 (1992) 35–42

    Google Scholar 

  48. Raffel C, JG McComb: To shunt or to fenestrate: Which is the best surgical treatment for arachnoid cysts in pediatric patients? Neurosurgery 23 (1988) 338–342

    Google Scholar 

  49. Raimondi AJ, R Shimoji, FA Gutierrez: Suprasellar cysts: surgical treatment and results. Child's Brain 7 (1980) 57–72

    Google Scholar 

  50. Rengachary SS: Intracranial arachnoid cysts and ependymal cysts. In:Wilkins R, SS Rengachary (eds). Neurosurgery, McGraw Hill, New York, 1985

    Google Scholar 

  51. Robinson RG: Congenital cysts of the brain: arachnoid malformations. Prog Neurol Surg 4 (1971) 133–174

    Google Scholar 

  52. Santamarta D, J Aguas, E Ferrer: The natural history of arachnoid cysts: endoscopic and cinemode MRI evidence of a slit-valve mechanism. Minim Invas Neurosurg 38 (1995) 133–137

    Google Scholar 

  53. Sekino T, N Tanaka, T Kuwabara: Intracranial arachnoid cysts: follow-up CT and clinical study. (Japanese) Nerv Syst in Children 10 (1985) 75–85

    Google Scholar 

  54. Shigemori M, A Okura, Y Takahashi, T Tokutomi: New surgical treatment of middle fossa arachnoid cyst. Surg Neural 45 (1996) 189–92

    Google Scholar 

  55. Starkman SP, TC Brown, EA Linel: Cerebral arachnoid cysts. J Neuropathol Exp Neurol 27 (1958) 484–500

    Google Scholar 

  56. Suga T, H Goto, M Sano: A case of complex brain anomaly with arachnoid cyst treated well by cyst-cisternal shunt. (Japanese) No Shinkei Geka 23 (1995) 717–21

    Google Scholar 

  57. Tsuda T, S Ueda, K Matsumoto: Clinicopathological study of the arachnoid cyst. (Japanese) Neurol Med Chir (Tokyo) 21 (1981) 501–509

    Google Scholar 

  58. Van der Meche FGA, R Braakman: Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and non-progressive symptoms. J Neurol Neurosurg Psych 46 (1983) 1102–1107

    Google Scholar 

  59. Villa AM, RE Sica: Persistent cerebellar ataxia after toxic administration of diphenylhydantoin. (Spanish) Arquivos de Neuro-Psiquiatria 52 (1994) 572–4

    Google Scholar 

  60. Von Wild K: Arachnoid cysts of the middle cranial fossa. Neurochirurgia 35 (1992) 177–182

    Google Scholar 

  61. Weber R, T Voit, C Lumenta, HG Lenard: Spontaneous regression of a temporal arachnoid cyst. Childs Nerv Syst 7 (1991) 414–5

    Google Scholar 

  62. Wesper K, NE Gilhus, K Hugdahl: Spontaneous disappearance of an arachnoid cyst in the middle intracranial fossa. Neurology 41 (1991) 1524–6

    Google Scholar 

  63. Wester K: Arachnoid cysts in adults: experience with internal shunts to the subdural compartment. Surg Neurol 45 (1996) 15–24

    Google Scholar 

  64. Williams B, AN Guthkelch: Why do central arachnoid pouches expand? J Neurol Neurosurg Psych 37 (1974) 1085–92

    Google Scholar 

  65. Yamakawa H, A Okhuma, T Hattori: Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases. Acta Neurochirurgica 113 (1991) 42–7

    Google Scholar 

  66. Yamanouchi Y, K Someda, N Oka: Spontaneous disappearance of middle fossa arachnoid cyst after head injury. Childs Nerv Syst 2 (1986) 40–43

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Medicine, Ohio State University Hospitals, Columbus, Ohio, USA

    Christian A. Koch

  2. Department of Neurology, Ohio State University Hospitals, Columbus, Ohio, USA

    J. Layne Moore

  3. Department of Neurosurgery, Johannes-Gutenberg-University Mainz, Germany

    Dieter Voth

  4. National Institute of Health (NICHD), Building 10, Room 10 N 262, 20892, Bethesda, MD, USA

    Christian A. Koch

Authors
  1. Christian A. Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Layne Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dieter Voth
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koch, C.A., Moore, J.L. & Voth, D. Arachnoid cysts: How do postsurgical cyst size and seizure outcome correlate?. Neurosurg. Rev. 21, 14–22 (1998). https://doi.org/10.1007/BF01111480

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01111480

Keywords

Search

Navigation