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

Clinical article

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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.


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.


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.


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.



  • 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).



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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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)


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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)


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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




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