Prevalence and natural history of arachnoid cysts in children

Clinical article

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Arachnoid cysts are a frequent finding on intracranial imaging in children. The prevalence and natural history of these cysts are not well defined. The authors studied a large consecutive series of children undergoing MR imaging to better define both the MR imaging–demonstrated prevalence and behavior of these lesions over time.


The authors reviewed a consecutive series of 11,738 patients who were 18 years of age or younger and had undergone brain MR imaging at a single institution during an 11-year period. In the patients in whom intracranial arachnoid cysts were identified, clinical and demographic information was recorded and imaging characteristics, such as cyst size and location, were evaluated. Prevalence data were analyzed using univariate and multivariate logistic regression, linear regression, and ANOVA. All patients with sufficient data (repeat MR imaging studies as well as repeated clinical evaluation over at least 5 months) for a natural history analysis were identified. This group was assessed for any change in symptoms or imaging appearance during the follow-up interval.


Three hundred nine arachnoid cysts (2.6% prevalence rate) were identified. There was an increased prevalence of arachnoid cysts in males (p < 0.000001). One hundred eleven patients met all criteria for inclusion in the natural history analysis. After a mean follow-up of 3.5 years, 11 arachnoid cysts increased in size, 13 decreased, and 87 remained stable. A younger age at presentation was significantly associated with cyst enlargement (p = 0.001) and the need for surgery (p = 0.05). No patient older than 4 years of age at the time of initial diagnosis had cyst enlargement, demonstrated new symptoms, or underwent surgical treatment.


Arachnoid cysts are a common incidental finding on intracranial imaging in pediatric patients. An older age at the time of presentation is associated with a lack of clinical or imaging changes over time.

Abbreviation used in this paper: EMERSE = The Electronic Medical Record Search Engine.

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:

© AANS, except where prohibited by US copyright law.



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    Scatterplot with linear trendline showing the relationship between age (in years) and arachnoid cyst prevalence.

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    Graph illustrating the prevalence of arachnoid cysts by age (in years) and sex. A male predominance is noted throughout the pediatric age range.

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    Axial (A) and coronal (B) T1-weighted MR images showing a typical arachnoid cyst. Follow-up axial (C) and coronal (D) images indicating interval cyst enlargement.

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    Axial (A) and sagittal (B) T1-weighted MR images revealing a typical arachnoid cyst. Axial (C) and sagittal (D) follow-up images showing interval cyst enlargement.



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


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


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


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


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


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


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


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


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


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


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


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


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


Haino KSerikawa TKikuchi ATakakuwa KTanaka K: Prenatal diagnosis of fetal arachnoid cyst of the quadrigeminal cistern in ultrasonography and MRI. Prenat Diagn 29:107810802009


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


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


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


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


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


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


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


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


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


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


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


Kusaka YLuedemann WOi SShwardfegar RSamii M: Fetal arachnoid cyst of the quadrigeminal cistern in MRI and ultrasound. Childs Nerv Syst 21:106510662005


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Shim KWLee YHPark EKPark YSChoi JUKim DS: Treatment option for arachnoid cysts. Childs Nerv Syst 2009


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


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


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


Tamburrini GDal Fabbro MDel Fabbro MDi Rocco C: Sylvian fissure arachnoid cysts: a survey on their diagnostic workout and practical management. Childs Nerv Syst 24:5936042008


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


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


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


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


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


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


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


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


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


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


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


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