Intracranial arachnoid cyst
Intracranial arachnoid cysts are fluid-filled cavities that arise within the cranial arachnoid.
These cystic lesions are congenital.
Epidemiology
Arachnoid cysts comprise 1% of all intracranial space-occupying lesions 1).
The prevalence in adults is approximately 1.4% with a female preponderance, while the prevalence in children is 2.6% 2) 3) 4).
Intracranial arachnoid cysts have a predilection for the temporal fossa.
Classification
Arachnoid cysts can be classified as primary developmental cysts or secondary cysts. Primary cysts arise from the splitting of the arachnoid membranes in utero, resulting in the development of anomalous collections of cerebrospinal fluid (CSF). Secondary cysts are less common, often appearing after trauma, surgery, infection, or intracranial hemorrhage.
Localization
Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch) 5).
50-66% occurring within the middle cranial fossa in most series. Ten percent occur in the suprasellar and quadrigeminal regions and approximately 5% each in the posterior fossa and over the frontal convexities
Supratentorial are divided into:
Sylvian fissure arachnoid cyst
Cerebral convexity
Interhemispheric arachnoid cyst
Sellar region
Intraventricular.
Quadrigeminal plate cistern
see Posterior fossa arachnoid cyst.
see Middle fossa arachnoid cyst.
Etiology
Many theories have been postulated for etiopathogenesis of arachnoid cysts. Various hypotheses are: entrapment of CSF in a diverticulum; CSF flow changes leading to arachnoid cell layer tears during the formation of various cisternae; during embryological separation (at around 15th week of gestation) of arachnoid from the dura mater 6).
Clinical features
see Intracranial arachnoid cyst clinical features.
Treatment
see Intracranial arachnoid cyst treatment.
Complications
Spontaneous intracystic hemorrhage in an arachnoid cyst is a rare complication (although hemorrhagic arachnoid cyst is well known in the clinical setting of trauma), which may present with symptoms of raised intracranial pressure (headache, vomiting, altered sensorium) or focal neurological deficits depending on the location and is an indication for surgery 7) 8).
Although complications such as intracystic, subdural, and extradural hematomas are well known after a trauma, spontaneous hemorrhage in an arachnoid cyst is a rare and serious complication with atypical imaging features on cross-sectional imaging and only less than ten cases are documented in the literature 9).
Outcome
see Intracranial arachnoid cyst outcome.
Case series
see Intracranial arachnoid cyst case series.
Case reports
see Intracranial arachnoid cyst case reports.