Location, sidedness, and sex distribution of intracranial arachnoid cysts in a population-based sample

Clinical article

Restricted access

Object

The aim of this study was to examine the distribution of intracranial arachnoid cysts in a large and unselected patient population with special emphasis on sidedness and sex distribution.

Methods

In total, 299 patients with 305 arachnoid cysts were studied. These patients were consecutively referred to our department during a 20-year period from a well-defined geographical area with a stable population.

Results

There was a strong predilection (198 patients [66.2%]) for intracranial arachnoid cysts in the temporal fossa. Forty-two patients had cysts overlying the frontal convexity, 36 had cysts in the posterior fossa, and 23 patients had cysts in other, different locations. Of 269 cysts with clearly unilateral distribution, 163 were located on the left side and 106 on the right side. This difference resulted from the marked preponderance of temporal fossa cysts on the left side (left-to-right ratio 2.5:1; p < 0.0001 [adjusted < 0.0005]). For cysts in the cerebellopontine angle (CPA), there was preponderance on the right side (p = 0.001 [adjusted = 0.005]). Significantly more males than females had cysts in the temporal fossa (p = 0.002 [adjusted = 0.004]), whereas in the CPA a significant female preponderance was found (p = 0.016 [adjusted = 0.032]). For all other cyst locations, there was no difference between the 2 sexes.

Conclusions

Arachnoid cysts have a strong predilection for the temporal fossa. There is a sex dependency for some intracranial locations of arachnoid cysts, with temporal cysts occurring more frequently in men, and CPA cysts found more frequently in women. Furthermore, there is a strong location-related sidedness for arachnoid cysts, independent of patient sex. These findings and reports from the literature suggest a possible genetic component in the development of some arachnoid cysts.

Abbreviations used in this paper: CPA = cerebellopontine angle; ICD = International Classification of Diseases.

Article Information

Address correspondence to: Christian A. Helland, M.D., Ph.D., Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway N-5021. email: chhe@helse-bergen.no.

Please include this information when citing this paper: published online January 22, 2010; DOI: 10.3171/2009.11.JNS081663.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Chart showing the sidedness of intracranial arachnoid cysts. * p < 0.0001 (adjusted < 0.0005); ** p < 0.0001 (adjusted < 0.0005); *** p = 0.006 (adjusted = 0.03); **** p = 0.001 (adjusted = 0.005).

  • View in gallery

    Chart showing the sex distribution in 299 patients related to location of the intracranial arachnoid cyst. * p < 0.0001; **p = 0.002 (adjusted = 0.004); ***p = 0.016 (adjusted = 0.032).

References

  • 1

    Agnoli AL: [Computer tomographic detection of an intraspinal arachnoid cyst.]. Rontgenblatter 37:3913931984. (German)

  • 2

    Alehan FKGürakan BAğildere M: Familial arachnoid cysts in association with autosomal dominant polycystic kidney disease. Pediatrics 110:e132002

    • Search Google Scholar
    • Export Citation
  • 3

    Anderson FMSegall HDCaton WL: Use of computerized tomography scanning in supratentorial arachnoid cysts. A report on 20 children and four adults. J Neurosurg 50:3333381979

    • Search Google Scholar
    • Export Citation
  • 4

    Arai HSato KWachi AOkuda OTakeda N: Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery 39:110811131996

    • Search Google Scholar
    • Export Citation
  • 5

    Arriola Gde Castro PVerdú A: Familial arachnoid cysts. Pediatr Neurol 33:1461482005

  • 6

    Artico MCervoni LSalvati MFiorenza FCaruso R: Supratentorial arachnoid cysts: clinical and therapeutic remarks on 46 cases. Acta Neurochir (Wien) 132:75781995

    • Search Google Scholar
    • Export Citation
  • 7

    Banna M: Arachnoid cysts on computed tomography. AJR Am J Roentgenol 127:9799821976

  • 8

    Bannister CMRussell SARimmer SMowle DH: Fetal arachnoid cysts: their site, progress, prognosis and differential diagnosis. Eur J Pediatr Surg 9:Suppl 127281999

    • Search Google Scholar
    • Export Citation
  • 9

    Caemaert JAbdullah JCalliauw L: Endoscopic diagnosis and treatment of para- and intra-ventricular cystic lesions. Acta Neurochir Suppl 61:69751994

    • Search Google Scholar
    • Export Citation
  • 10

    Caemaert JAbdullah JCalliauw LCarton DDhooge Cvan Coster R: Endoscopic treatment of suprasellar arachnoid cysts. Acta Neurochir (Wien) 119:68731992

    • Search Google Scholar
    • Export Citation
  • 11

    Callaway MPRenowden SALewis TTBradshaw JMalcolm GCoakham H: Middle cranial fossa arachnoid cysts: not always a benign entity. Br J Radiol 71:4414431998

    • Search Google Scholar
    • Export Citation
  • 12

    Choi JUKim DS: Pathogenesis of arachnoid cyst: congenital or traumatic?. Pediatr Neurosurg 29:2602661998

  • 13

    Ciricillo SFCogen PHHarsh GREdwards MS: Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting. J Neurosurg 74:2302351991

    • Search Google Scholar
    • Export Citation
  • 14

    Daneyemez MGezen FAkbörü MSirin SOcal E: Presentation and management of supratentorial and infratentorial arachnoid cysts. Review of 25 cases. J Neurosurg Sci 43:1151231999

    • Search Google Scholar
    • Export Citation
  • 15

    Dei-Anang KVoth D: Cerebral arachnoid cyst: a lesion of the child's brain. Neurosurg Rev 12:59621989

  • 16

    Dhooge CGovaert PMartens FCaemaert J: Transventricular endoscopic investigation and treatment of suprasellar arachnoid cysts. Neuropediatrics 23:2452471992

    • Search Google Scholar
    • Export Citation
  • 17

    Elhammady MSBhatia SRagheb J: Endoscopic fenestration of middle fossa arachnoid cysts: a technical description and case series. Pediatr Neurosurg 43:2092152007

    • Search Google Scholar
    • Export Citation
  • 18

    Erdinçler PKaynar MYBozkus HCiplak N: Posterior fossa arachnoid cysts. Br J Neurosurg 13:10171999

  • 19

    Erman TGöçer AITuna MErgin MZorludemir SÇetinalp E: Intracranial arachnoid cysts. Clinical features and management of 35 cases and review of the literature. Neurosurg Q 14:84892004

    • Search Google Scholar
    • Export Citation
  • 20

    Eskandary HSabba MKhajehpour FEskandari M: Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 63:5505532005

    • Search Google Scholar
    • Export Citation
  • 21

    Fewel MELevy MLMcComb JG: Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 25:1651731996

    • Search Google Scholar
    • Export Citation
  • 22

    Galassi EGaist GGiuliani GPozzati E: Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically. Acta Neurochir Suppl (Wien) 42:2012041988

    • Search Google Scholar
    • Export Citation
  • 23

    Galassi ETognetti FGaist GFagioli LFrank FFrank G: CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol 17:3633691982

    • Search Google Scholar
    • Export Citation
  • 24

    Gangemi MColella GMagro FMaiuri F: Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 21:2762802007

    • Search Google Scholar
    • Export Citation
  • 25

    Garcia-Bach MIsamat FVila F: Intracranial arachnoid cysts in adults. Acta Neurochir Suppl (Wien) 42:2052091988

  • 26

    Geissinger JDKohler WCRobinson BWDavis FM: Arachnoid cysts of the middle cranial fossa: surgical considerations. Surg Neurol 10:27331978

    • Search Google Scholar
    • Export Citation
  • 27

    Go KG: The diagnosis and treatment of intracranial arachnoid cysts. Neurosurg Q 5:1872041995

  • 28

    Gosalakkal JA: Intracranial arachnoid cysts in children: a review of pathogenesis, clinical features, and management. Pediatr Neurol 26:93982002

    • Search Google Scholar
    • Export Citation
  • 29

    Gundersen HHelland CARaeder MBHugdahl KWester K: Visual attention in patients with intracranial arachnoid cysts. J Neurol 254:60662007

    • Search Google Scholar
    • Export Citation
  • 30

    Handa JOkamoto KSato M: Arachnoid cyst of the middle cranial fossa: report of bilateral cysts in siblings. Surg Neurol 16:1271301981

    • Search Google Scholar
    • Export Citation
  • 31

    Hanieh ASimpson DANorth JB: Arachnoid cysts: a critical review of 41 cases. Childs Nerv Syst 4:92961988

  • 32

    Harsh GR IVEdwards MSWilson CB: Intracranial arachnoid cysts in children. J Neurosurg 64:8358421986

  • 33

    Hayashi TAnegawa SHonda EKuramoto SMori KMurata T: Clinical analysis of arachnoid cysts in the middle fossa. Neurochirurgia (Stuttg) 22:2012101979

    • Search Google Scholar
    • Export Citation
  • 34

    Helland CAWester K: Arachnoid cysts in adults: long-term follow-up of patients treated with internal shunts to the subdural compartment. Surg Neurol 66:56612006

    • Search Google Scholar
    • Export Citation
  • 35

    Helland CAWester K: Intracystic pressure in patients with temporal arachnoid cysts: a prospective study of preoperative complaints and postoperative outcome. J Neurol Neurosurg Psychiatry 78:6206232007

    • Search Google Scholar
    • Export Citation
  • 36

    Helland CAWester K: Monozygotic twins with mirror image cysts: indication of a genetic mechanism in arachnoid cysts?. Neurology 69:1101112007

    • Search Google Scholar
    • Export Citation
  • 37

    Helland CAWester K: A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry 78:112911352007

    • Search Google Scholar
    • Export Citation
  • 38

    Helland CAWester K: A population-based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in children. J Neurosurg 105:5 Suppl3853902006

    • Search Google Scholar
    • Export Citation
  • 39

    Hoffman HJHendrick EBHumphreys RPArmstrong EA: Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57:5976021982

    • Search Google Scholar
    • Export Citation
  • 40

    Hugdahl KWester K: Rapid recovery of impaired cognitive functions after decompressive surgery in patients with arachnoid cysts. J Clin Exp Neuropsychol 15:991001993

    • Search Google Scholar
    • Export Citation
  • 41

    Iqbal JKanaan IAl Homsi M: Non-neoplastic cystic lesions of the sellar region presentation, diagnosis and management of eight cases and review of the literature. Acta Neurochir (Wien) 141:3893981999

    • Search Google Scholar
    • Export Citation
  • 42

    Jadeja KJGrewal RP: Familial arachnoid cysts associated with oculopharyngeal muscular dystrophy. J Clin Neurosci 10:1251272003

  • 43

    Jallo GIWoo HHMeshki CEpstein FJWisoff JH: Arachnoid cysts of the cerebellopontine angle: diagnosis and surgery. Neurosurgery 40:31381997

    • Search Google Scholar
    • Export Citation
  • 44

    Jamjoom ZAOkamoto EJamjoom AHal-Hajery OAbu-Melha A: Bilateral arachnoid cysts of the sylvian region in female siblings with glutaric aciduria type I. Report of two cases. J Neurosurg 82:107810811995

    • Search Google Scholar
    • Export Citation
  • 45

    Kandenwein JARichter HPBörm W: Surgical therapy of symptomatic arachnoid cysts—an outcome analysis. Acta Neurochir (Wien) 146:131713222004

    • Search Google Scholar
    • Export Citation
  • 46

    Kang JKLee KSLee IWJeun SSSon BCJung CK: Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children. Childs Nerv Syst 16:1111162000

    • Search Google Scholar
    • Export Citation
  • 47

    Katzman GLDagher APPatronas NJ: Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 282:36391999

    • Search Google Scholar
    • Export Citation
  • 48

    Kirollos RWJavadpour MMay PMallucci C: Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 17:7137182001

    • Search Google Scholar
    • Export Citation
  • 49

    Lang WLang MKornhuber AGallwitz AKriebel J: Neuropsychological and neuroendocrinological disturbances associated with extracerebral cysts of the anterior and middle cranial fossa. Eur Arch Psychiatry Neurol Sci 235:38411985

    • Search Google Scholar
    • Export Citation
  • 50

    Lena GErdincler PVan Calenberg FGenitori LChoux M: [Arachnoid cysts of the middle cranial fossa in children. A review of 75 cases, 47 of which have been operated in a comparative study between membranectomy with opening of cisterns and cystoperitoneal shunt.]. Neurochirurgie 42:29341996. (Fr)

    • Search Google Scholar
    • Export Citation
  • 51

    Levy MLMeltzer HSHughes SAryan HEYoo KAmar AP: Hydrocephalus in children with middle fossa arachnoid cysts. J Neurosurg 101:1 Suppl25312004

    • Search Google Scholar
    • Export Citation
  • 52

    Locatelli DBonfanti NSfogliarini RGajno TMPezzotta S: Arachnoid cysts: diagnosis and treatment. Childs Nerv Syst 3:1211241987

    • Search Google Scholar
    • Export Citation
  • 53

    Lodrini SLasio GFornari MMiglivacca F: Treatment of supratentorial primary arachnoid cysts. Acta Neurochir (Wien) 76:1051101985

    • Search Google Scholar
    • Export Citation
  • 54

    Marin-Sanabria EAYamamoto HNagashima TKohmura E: Evaluation of the management of arachnoid cyst of the posterior fossa in pediatric population: experience over 27 years. Childs Nerv Syst 23:5355422007

    • Search Google Scholar
    • Export Citation
  • 55

    Marinov MUndjian SWetzka P: An evaluation of the surgical treatment of intracranial arachnoid cysts in children. Childs Nerv Syst 5:1771831989

    • Search Google Scholar
    • Export Citation
  • 56

    Mayr UAichner FBauer GMohsenipour IPallua A: Supratentorial extracerebral cysts of the middle cranial fossa. A report of 23 consecutive cases of the so-called temporal lobe agenesis syndrome. Neurochirurgia (Stuttg) 25:51561982

    • Search Google Scholar
    • Export Citation
  • 57

    Merta MRysavá R: [Brain disorders in autosomal dominant polycystic kidney disease.]. Sb Lek 97:4794851996. (Czech)

  • 58

    Oberbauer RWHaase JPucher R: Arachnoid cysts in children: a European co-operative study. Childs Nerv Syst 8:2812861992

  • 59

    Orlacchio AGaudiello FTotaro AFloris RSt George-Hyslop PHBernardi G: A new SPG4 mutation in a variant form of spastic paraplegia with congenital arachnoid cysts. Neurology 62:187518782004

    • Search Google Scholar
    • Export Citation
  • 60

    Pascual-Castroviejo IRoche MCMartínez Bermejo AArcas JGarcía Blázquez M: Primary intracranial arachnoidal cysts. A study of 67 childhood cases. Childs Nerv Syst 7:2572631991

    • Search Google Scholar
    • Export Citation
  • 61

    Pomeranz SConstantini SLubetzki-Korn IAmir N: Familial intracranial arachnoid cysts. Childs Nerv Syst 7:1001021991

  • 62

    Pradilla GJallo GI: Arachnoid cysts: case series and review of the literature. Neurosurg Focus 22:2E72007

  • 63

    Raeder MBHelland CAHugdahl KWester K: Arachnoid cysts cause cognitive deficits that improve after surgery. Neurology 64:1601622005

    • Search Google Scholar
    • Export Citation
  • 64

    Rappaport ZH: Suprasellar arachnoid cysts: options in operative management. Acta Neurochir (Wien) 122:71751993

  • 65

    Rengachary SSIntracranial arachnoid and ependymal cysts. Wilkins RHRengachary SS: Neurosurgery New YorkMcGraw-Hill1985. 21602172

    • Search Google Scholar
    • Export Citation
  • 66

    Rengachary SSWatanabe I: Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61831981

  • 67

    Richard KEDahl KSanker P: Long-term follow-up of children and juveniles with arachnoid cysts. Childs Nerv Syst 5:1841871989

  • 68

    Rogers MAKlug GLSiu KH: Middle fossa arachnoid cysts in association with subdural haematomas. A review and recommendations for management. Br J Neurosurg 4:4975021990

    • Search Google Scholar
    • Export Citation
  • 69

    Sakai NKumagai MUeda TIwamura MNishimura YMiwa Y: [Clinical study on intracranial arachnoid cyst: with reference to the middle cranial fossa.]. No Shinkei Geka 17:1171231989. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 70

    Samii MCarvalho GASchuhmann MUMatthies C: Arachnoid cysts of the posterior fossa. Surg Neurol 51:3763821999

  • 71

    Sato KShimoji TYaguchi KSumie HKuru YIshii S: Middle fossa arachnoid cyst: clinical, neuroradiological, and surgical features. Childs Brain 10:3013161983

    • Search Google Scholar
    • Export Citation
  • 72

    Schönherr BWolf OMeier U: Endoscopy of intracranial cysts in the adult patient. Minim Invasive Neurosurg 45:1811842002

  • 73

    Sharma ASayal PBadhe PPandey ADiyora BIngale H: Spinal intramedullary arachnoid cyst. Indian J Pediatr 71:e65e672004

  • 74

    Sinha SBrown JI: Familial posterior fossa arachnoid cyst. Childs Nerv Syst 20:1001032004

  • 75

    Smith RASmith WA: Arachnoid cysts of the middle cranial fossa. Surg Neurol 5:2462521976

  • 76

    Sommer IESmit LM: Congenital supratentorial arachnoidal and giant cysts in children: a clinical study with arguments for a conservative approach. Childs Nerv Syst 13:8121997

    • Search Google Scholar
    • Export Citation
  • 77

    Stachura KCzepko R: [Results of neuroendoscopic treatment of arachnoid cysts in adults.]. Neurol Neurochir Pol 40:3913962006. (Polish)

    • Search Google Scholar
    • Export Citation
  • 78

    van der Meché FGBraakman R: Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and nonprogressive symptoms. J Neurol Neurosurg Psychiatry 46:110211071983

    • Search Google Scholar
    • Export Citation
  • 79

    Vernooij MWIkram MATanghe HLVincent AJHofman AKrestin GP: Incidental findings on brain MRI in the general population. N Engl J Med 357:182118282007

    • Search Google Scholar
    • Export Citation
  • 80

    von Wild K: Arachnoid cysts of the middle cranial fossa. Neurochirurgia (Stuttg) 35:1771821992

  • 81

    Wester K: Arachnoid cysts in adults: experience with internal shunts to the subdural compartment. Surg Neurol 45:15241996

  • 82

    Wester K: Gender distribution and sidedness of middle fossa arachnoid cysts: a review of cases diagnosed with computed imaging. Neurosurgery 31:9409441992

    • Search Google Scholar
    • Export Citation
  • 83

    Wester K: Peculiarities of intracranial arachnoid cysts: location, sidedness, and sex distribution in 126 consecutive patients. Neurosurgery 45:7757791999

    • Search Google Scholar
    • Export Citation
  • 84

    Wester KGilhus NEHugdahl KLarsen JL: Spontaneous disappearance of an arachnoid cyst in the middle intracranial fossa. Neurology 41:152415261991

    • Search Google Scholar
    • Export Citation
  • 85

    Wester KHelland CA: How often do chronic extra-cerebral haematomas occur in patients with intracranial arachnoid cysts?. J Neurol Neurosurg Psychiatry 79:72752008

    • Search Google Scholar
    • Export Citation
  • 86

    Wester KHugdahl K: Arachnoid cysts of the left temporal fossa: impaired preoperative cognition and postoperative improvement. J Neurol Neurosurg Psychiatry 59:2932981995

    • Search Google Scholar
    • Export Citation
  • 87

    Wester KHugdahl K: Verbal laterality and handedness in patients with intracranial arachnoid cysts. J Neurol 250:36412003

  • 88

    Wijdicks EFTorres VESchievink WI: Chronic subdural hematoma in autosomal dominant polycystic kidney disease. Am J Kidney Dis 35:40432000

    • Search Google Scholar
    • Export Citation
  • 89

    Yamakawa HOhkuma AHattori TNiikawa SKobayashi H: Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases. Acta Neurochir (Wien) 113:42471991

    • Search Google Scholar
    • Export Citation
  • 90

    Zúccaro GSosa F: Cerebellopontine angle lesions in children. Childs Nerv Syst 23:1771832007

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 223 223 23
Full Text Views 153 153 1
PDF Downloads 135 135 0
EPUB Downloads 0 0 0

PubMed

Google Scholar