Prevalence and natural history of arachnoid cysts in adults

Clinical article

Restricted access

Object

Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined.

Methods

We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis.

Results

A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period.

Conclusions

Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.

Abbreviation used in this paper:CPA = cerebellopontine angle.

Article Information

Address correspondence to: Cormac O. Maher, M.D., Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552 Taubman Center, Ann Arbor, Michigan 48109-5338. email: cmaher@med.umich.edu.

Please include this information when citing this paper: published online November 9, 2012; DOI: 10.3171/2012.10.JNS12548.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graph illustrating arachnoid cyst prevalence in patients undergoing MRI stratified by sex and age group. Imaging prevalence of arachnoid cysts in males is greater than in females (p < 0.00001). The prevalence of arachnoid cysts does not change significantly with advancing age in adulthood.

References

  • 1

    Al-Holou WNTerman SWKilburg CGarton HJMuraszko KMChandler WF: Prevalence and natural history of pineal cysts in adults. Clinical article. J Neurosurg 115:110611142011

  • 2

    Al-Holou WNYew AYBoomsaad ZEGarton HJMuraszko KMMaher CO: Prevalence and natural history of arachnoid cysts in children. Clinical article. J Neurosurg Pediatr 5:5785852010

  • 3

    Albuquerque FCGiannotta SL: Arachnoid cyst rupture producing subdural hygroma and intracranial hypertension: case reports. Neurosurgery 41:9519561997

  • 4

    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

  • 5

    Anik YAnik IGonullu EInan NDemirci A: Proteus syndrome with syringohydromyelia and arachnoid cyst. Childs Nerv Syst 23:119912032007

  • 6

    Ashker LWeinstein JMDias MKanev PNguyen DBonsall DJ: Arachnoid cyst causing third cranial nerve palsy manifesting as isolated internal ophthalmoplegia and iris cholinergic supersensitivity. J Neuroophthalmol 28:1921972008

  • 7

    Auer LMGallhofer BLadurner GSager WDHeppner FLechner H: Diagnosis and treatment of middle fossa arachnoid cysts and subdural hematomas. J Neurosurg 54:3663691981

  • 8

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

  • 9

    Bechter KWittek RSeitz KAntoniadis G: Personality disorders improved after arachnoid cyst neurosurgery, then rediagnosed as ‘minor' organic personality disorders. Psychiatry Res 184:1962002010

  • 10

    Bilginer BOnal MBOguz KKAkalan N: Arachnoid cyst associated with subdural hematoma: report of three cases and review of the literature. Childs Nerv Syst 25:1191242009

  • 11

    Boomkens HRvan der Cammen TJMattace-Raso FU: Primary arachnoid cyst mimicking depressive symptoms in an elderly woman. Int Psychogeriatr 22:8328332010

  • 12

    Boutarbouch MEl Ouahabi ARifi LArkha YDerraz SEl Khamlichi A: Management of intracranial arachnoid cysts: institutional experience with initial 32 cases and review of the literature. Clin Neurol Neurosurg 110:172008

  • 13

    Chu DCFinley SCYoung DWProud VK: CNS malformation in a child with Kabuki (Niikawa-Kuroki) syndrome: report and review. Am J Med Genet 72:2052091997

  • 14

    Cilluffo JMOnofrio BMMiller RH: The diagnosis and surgical treatment of intracranial arachnoid cysts. Acta Neurochir (Wien) 67:2152291983

  • 15

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

  • 16

    Columbano LLuedemann WKusaka YOi SSamii M: Prenatal diagnosed cyst of the quadrigeminal cistern in Aicardi syndrome. Childs Nerv Syst 25:5215222009

  • 17

    de-Melo-Neto VLLopes FLMagalhães FVDomingues RCHallak JECrippa JA: Anterior cingulate cortex activation as a trait of panic disorder in a patient with a temporal arachnoid cyst. Prog Neuropsychopharmacol Biol Psychiatry 33:156515672009

  • 18

    Demir HDDeniz FEYardim H: A rare brain developmental anomaly in a patient with Usher's syndrome. Int Ophthalmol 30:85882010

  • 19

    Dholakia SYShah PSPrakash S: Conversion disorder in a patient with posterior fossa arachnoid cyst. J Neuropsychiatry Clin Neurosci 22:123E7E123E82010. (Letter)

  • 20

    Di Rocco C: Sylvian fissure arachnoid cysts: we do operate on them but should it be done?. Childs Nerv Syst 26:1731752010

  • 21

    Di Rocco CTamburrini GCaldarelli MVelardi FSantini P: Prolonged ICP monitoring in Sylvian arachnoid cysts. Surg Neurol 60:2112182003

  • 22

    Di Rocco CVelardi F: Acquired Chiari type I malformation managed by supratentorial cranial enlargement. Childs Nerv Syst 19:8008072003

  • 23

    Domenicucci MRusso NGiugni EPierallini A: Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment. Clinical article. J Neurosurg 110:125012552009

  • 24

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

  • 25

    Ergün ROkten AIBeşkonakli EAnasiz HErgüngör FTaşkin Y: Unusual complication of arachnoid cyst: spontaneous rupture into the subdural space. Acta Neurochir (Wien) 139:6926941997

  • 26

    Ergün ROkten AIGezercan YGezici AR: Sturge-Weber syndrome accompanied with multiple congenital intracranial lesions. Acta Neurochir (Wien) 149:8298302007

  • 27

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

  • 28

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

  • 29

    Galassi ETognetti FFrank FFagioli LNasi MTGaist G: Infratentorial arachnoid cysts. J Neurosurg 63:2102171985

  • 30

    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

  • 31

    Gangemi MSeneca VColella GCioffi VImperato AMaiuri F: Endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid cysts. Clinical article. J Neurosurg Pediatr 8:1581642011

  • 32

    Go KGHouthoff HJBlaauw EHHavinga PHartsuiker J: Arachnoid cysts of the sylvian fissure. Evidence of fluid secretion. J Neurosurg 60:8038131984

  • 33

    Hanauer DA: EMERSE: The Electronic Medical Record Search Engine. AMIA Annu Symp Proc 2006:9412006

  • 34

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

  • 35

    Helland CALund-Johansen MWester K: Location, sidedness, and sex distribution of intracranial arachnoid cysts in a population-based sample. Clinical article. J Neurosurg 113:9349392010

  • 36

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

  • 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

  • 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

  • 39

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

  • 40

    Holmes LBRedline RWBrown DLWilliams AJCollins T: Absence/hypoplasia of tibia, polydactyly, retrocerebellar arachnoid cyst, and other anomalies: an autosomal recessive disorder. J Med Genet 32:8969001995

  • 41

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

  • 42

    Jayarao MDevaiah AKChin LS: Recovery of sensorineural hearing loss following operative management of a posterior fossa arachnoid cyst. Case report. J Neurosurg Pediatr 4:1211242009

  • 43

    Johnson RDChapman SBojanic S: Endoscopic fenestration of middle cranial fossa arachnoid cysts: does size matter?. J Clin Neurosci 18:6076122011

  • 44

    Kalapatapu RK: Aripiprazole treatment of psychosis in a child with posterior fossa retrocerebellar arachnoid cyst. J Child Adolesc Psychopharmacol 19:3213252009

  • 45

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

  • 46

    Kang SYChoi JCKang JHLee JS: Huge supratentorial arachnoid cyst presenting as an orgasmic headache. Neurol Sci 33:5395412012

  • 47

    Kara BKayserili HImer MCalişkan MOzmen M: Quadrigeminal cistern arachnoid cyst in a patient with Kabuki syndrome. Pediatr Neurol 34:4784802006

  • 48

    Karabagli HEtus V: Success of pure neuroendoscopic technique in the treatment of Sylvian arachnoid cysts in children. Childs Nerv Syst 28:4454522012

  • 49

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

  • 50

    Kim BSIlles JKaplan RTReiss AAtlas SW: Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 23:167416772002

  • 51

    Kim SKCho BKChung YNKim HSWang KC: Shunt dependency in shunted arachnoid cyst: a reason to avoid shunting. Pediatr Neurosurg 37:1781852002

  • 52

    Kouyialis ATStranjalis GBoviatsis EJZiaka DSBouras TISakas DE: Recurrence of trigeminal neuralgia due to an acquired arachnoid cyst. J Clin Neurosci 15:140914112008

  • 53

    Kuloglu MCaykoylu AYilmaz EEkinci O: A left temporal lobe arachnoid cyst in a patient with schizophrenia-like psychosis: a case report. Prog Neuropsychopharmacol Biol Psychiatry 32:135313542008

  • 54

    Kurabe SSasaki OMitsuhashi DKoike T: Growing posterior fossa arachnoid cyst causing tonsillar herniation and hydrocephalus. Arch Neurol 68:160616072011

  • 55

    Levy MLWang MAryan HEYoo KMeltzer H: Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 53:113811452003

  • 56

    Maher COGoumnerova L: The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts. Clinical article. J Neurosurg Pediatr 7:64722011

  • 57

    Maixner VJBesser MJohnston IH: Pseudotumor syndrome in treated arachnoid cysts. Childs Nerv Syst 8:2072101992

  • 58

    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

  • 59

    Martin MMLockspieler TSlavotinek AM: Oculo-ectodermal syndrome: is arachnoid cyst a common finding?. Clin Dysmorphol 16:35382007

  • 60

    Martínez-Lage JFPérez-Espejo MAAlmagro MJLópez-Guerrero AL: Hydrocephalus and arachnoid cysts. Childs Nerv Syst 27:164316522011

  • 61

    Martínez-Lage JFPoza MRodriguez Costa T: Bilateral temporal arachnoid cysts in neurofibromatosis. J Child Neurol 8:3833851993

  • 62

    Martínez-Lage JFRuíz-Espejo AMAlmagro MJAlfaro RFelipe-Murcia MLópez-Guerrero AL: CSF overdrainage in shunted intracranial arachnoid cysts: a series and review. Childs Nerv Syst 25:106110692009

  • 63

    Martínez-Lage JFValentí JAPiqueras CRuiz-Espejo AMRomán FNuño de la Rosa JA: Functional assessment of intracranial arachnoid cysts with TC99 m-HMPAO SPECT: a preliminary report. Childs Nerv Syst 22:109110972006

  • 64

    McDonald PJRutka JT: Middle cranial fossa arachnoid cysts that come and go. Report of two cases and review of the literature. Pediatr Neurosurg 26:48521997

  • 65

    McLaughlin NVandergrift ADitzel Filho LFShahlaie KEisenberg AACarrau RL: Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique. Technical note. J Neurosurg 116:7287402012

  • 66

    Mori KYamamoto THorinaka NMaeda M: Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma 19:101710272002

  • 67

    Mottolese CSzathmari ASimon EGinguene CRicci-Franchi ACHermier M: The parallel use of endoscopic fenestration and a cystoperitoneal shunt with programmable valve to treat arachnoid cysts: experience and hypothesis. Clinical article. J Neurosurg Pediatr 5:4084142010

  • 68

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

  • 69

    Oertel JMWagner WMondorf YBaldauf JSchroeder HWGaab MR: Endoscopic treatment of arachnoid cysts: a detailed account of surgical techniques and results. Neurosurgery 67:8248362010

  • 70

    Okumura YSakaki THirabayashi H: Middle cranial fossa arachnoid cyst developing in infancy. Case report. J Neurosurg 82:107510771995

  • 71

    Parsch CSKrauss JHofmann EMeixensberger JRoosen K: Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 40:4834901997

  • 72

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

  • 73

    Raffel CMcComb JG: To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?. Neurosurgery 23:3383421988

  • 74

    Rao GAnderson RCFeldstein NABrockmeyer DL: Expansion of arachnoid cysts in children: report of two cases and review of the literature. J Neurosurg 102:3 Suppl3143172005

  • 75

    Robinson RG: Congenital cysts of the brain: arachnoid malformations. Prog Neurol Surg 4:1331741971

  • 76

    Russo NDomenicucci MBeccaglia MRSantoro A: Spontaneous reduction of intracranial arachnoid cysts: a complete review. Br J Neurosurg 22:6266292008

  • 77

    Schievink WIHuston J IIITorres VEMarsh WR: Intracranial cysts in autosomal dominant polycystic kidney disease. J Neurosurg 83:100410071995

  • 78

    Seizeur RForlodou PCoustans MDam-Hieu P: Spontaneous resolution of arachnoid cysts: review and features of an unusual case. Acta Neurochir (Wien) 149:75782007

  • 79

    Shim KWLee YHPark EKPark YSChoi JUKim DS: Treatment option for arachnoid cysts. Childs Nerv Syst 25:145914662009

  • 80

    Spacca BKandasamy JMallucci CLGenitori L: Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres. Childs Nerv Syst 26:1631722010

  • 81

    Struck AFMurphy MJIskandar BJ: Spontaneous development of a de novo suprasellar arachnoid cyst.Case report. J Neurosurg 104:6 Suppl4264282006

  • 82

    Sun TZhao J: Multiple saccular aneurysms of the extracranial and intracranial internal carotid artery associated with convexobasia and arachnoid cyst in a 6-year-old boy: a case report. Childs Nerv Syst 26:1131162010

  • 83

    Suzuki HTakanashi JSugita KBarkovich AJKohno Y: Retrocerebellar arachnoid cysts in siblings with mental retardation and undescended testis. Brain Dev 24:3103132002

  • 84

    Talamonti GD'Aliberti GPicano MDebernardi ACollice M: Intracranial cysts containing cerebrospinal fluid-like fluid: results of endoscopic neurosurgery in a series of 64 consecutive cases. Neurosurgery 68:7888032011

  • 85

    Tamburrini GCaldarelli MMassimi LSantini PDi Rocco C: Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst 19:1591652003

  • 86

    Tamburrini GDal Fabbro MDi Rocco C: Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management. Childs Nerv Syst 24:5936042008. (Erratum in Childs Nerv Syst 24:635 2008)

  • 87

    Thinakara-Rajan TJanjua ASrinivasan V: Posterior fossa arachnoid cyst presenting with isolated sensorineural hearing loss. J Laryngol Otol 120:9799822006

  • 88

    Thomas BPPearson MMWushensky CA: Active spontaneous decompression of a suprasellar-prepontine arachnoid cyst detected with routine magnetic resonance imaging.Case report. J Neurosurg Pediatr 3:70722009

  • 89

    Tiple DDe Angelis FSpallone AColosimo C: Neurological picture. Secondary parkinsonism due to arachnoid cyst of the frontal lobe. J Neurol Neurosurg Psychiatry 81:4002010

  • 90

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

  • 91

    Wang JCHeier LSouweidane MM: Advances in the endoscopic management of suprasellar arachnoid cysts in children. J Neurosurg 100:5 Suppl Pediatrics4184262004

  • 92

    Wang YQiu BLi PCheng PLi GLi X: Multifocal intraparenchymal Langerhans' cell histiocytosis concomitant with an arachnoid cyst in a child: case report and review of the literature. J Child Neurol 27:7677782012

  • 93

    Weber FKnopf H: Incidental findings in magnetic resonance imaging of the brains of healthy young men. J Neurol Sci 240:81842006

  • 94

    Weber RVoit TLumenta CLenard HG: Spontaneous regression of a temporal arachnoid cyst. Childs Nerv Syst 7:4144151991

  • 95

    Weir B: Leptomeningeal cysts in congenital ectopia lentis. Case report. J Neurosurg 38:6506541973

  • 96

    Welch KOTekin MNance WEBlanton SHArnos KSPandya A: Chudley-McCullough syndrome: expanded phenotype and review of the literature. Am J Med Genet A 119A:71762003

  • 97

    Wester K: Intracranial arachnoid cysts—do they impair mental functions?. J Neurol 255:111311202008

  • 98

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

  • 99

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

  • 100

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

  • 101

    Wilkinson CCWinston KRCongenital arachnoid cysts and the Dandy-Walker complex. Albright ALPollack IFAdelson PD: Principles and Practice of Pediatric Neurosurgery ed 2New YorkThieme2007. 162186

  • 102

    Wilson WGDeponte KAMcIlhenny JDreifuss FE: Arachnoid cysts in a brother and sister. J Med Genet 25:7147151988

  • 103

    Yacubian-Fernandes APalhares AGiglio AGabarra RCZanini SPortela L: Apert syndrome: analysis of associated brain malformations and conformational changes determined by surgical treatment. J Neuroradiol 31:1161222004

  • 104

    Yanaka KEnomoto TNose TMaki Y: Post-inflammatory arachnoid cyst of the quadrigeminal cistern. Observation of development of the cyst. Childs Nerv Syst 4:3023051988

  • 105

    Yang SHLee KSSung JHSon BCJeun SSKang JK: Surgical decompression of supratentorial arachnoid cysts in pediatric patients younger than one year. Pediatr Neurosurg 44:4654702008

  • 106

    Zada GKrieger MDMcNatt SABowen IMcComb JG: Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age. Neurosurg Focus 22:2E12007

  • 107

    Zhou JYPu JLChen SHong YLing CHZhang JM: Mirror-image arachnoid cysts in a pair of monozygotic twins: a case report and review of the literature. Int J Med Sci 8:4024052011

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 1511 1511 350
Full Text Views 1235 1235 16
PDF Downloads 410 410 16
EPUB Downloads 0 0 0

PubMed

Google Scholar