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'''Arachnoid cysts''' are [[cerebrospinal fluid]] covered by [[arachnoid mater |arachnoidal cells]] and [[collagen]]<ref name="pn">Ariai S, Koerbel A, Bornemann A, Morgala M, Tatagiba M. "Cerebellopontine angle arachnoid cyst harbouring ectopic neuroglia", ''Pediatr Neurosurg.'' 2005 Jul-Aug;41(4):220-3. ({{PMID|16088260}})</ref> that may develop between the surface of the [[human brain|brain]] and the cranial base or on the [[arachnoid membrane]], one of the three [[meningeal layers]] that cover the brain and the [[spinal cord]].<ref name="ninds">{{cite web | url=https://www.ninds.nih.gov/Disorders/All-Disorders/Arachnoid-Cysts-Information-Page | title=Arachnoid Cysts Information Page | publisher=[[NINDS]] | accessdate=April 7, 2017}}</ref> Arachnoid cysts are a [[congenital disorder]],<ref>Gelabert-Gonzalez M. "Intracranial arachnoid cysts", ''Rev Neurol.'', 2004 Dec 16-31;39(12):1161-6. ({{PMID|15625636}})</ref> and most cases begin during infancy; however, onset may be delayed until adolescence.<ref name="ninds" />
'''Arachnoid cysts''' are [[cerebrospinal fluid]] covered by [[arachnoid mater |arachnoidal cells]] and [[collagen]]<ref name="pmid16088260">{{cite journal | vauthors = Ariai S, Koerbel A, Bornemann A, Morgala M, Tatagiba M | title = Cerebellopontine angle arachnoid cyst harbouring ectopic neuroglia | journal = Pediatr Neurosurg | volume = 41 | issue = 4 | pages = 220–3 | date = 2005 | pmid = 16088260 | doi = 10.1159/000086566 }}</ref> that may develop between the surface of the [[human brain|brain]] and the cranial base or on the [[arachnoid membrane]], one of the three [[meningeal layers]] that cover the brain and the [[spinal cord]].<ref name="ninds">{{cite web | url=https://www.ninds.nih.gov/Disorders/All-Disorders/Arachnoid-Cysts-Information-Page | title=Arachnoid Cysts Information Page | publisher=[[NINDS]] | accessdate=April 7, 2017}}</ref> Arachnoid cysts are a [[congenital disorder]],<ref name="pmid15625636">{{cite journal | vauthors = Gelabert-González M | title = Intracranial arachnoid cysts]| language = Spanish | journal = Rev Neurol | volume = 39 | issue = 12 | pages = 1161–6 | date = 2004 | pmid = 15625636 }}</ref> and most cases begin during infancy; however, onset may be delayed until adolescence.<ref name="ninds" />


==Classification==
==Classification==
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*Cranial deformation or [[macrocephaly]] (enlargement of the head), particularly in children<ref name="azguide">Barker RA, Scolding N, Rowe D, Larner AJ. ''The A-Z of Neurological Practice: A Guide to Clinical Neurology'' [[Cambridge University Press]] 2005 Jan 10, p61. ({{ISBN|0-521-62960-8}})</ref>
*Cranial deformation or [[macrocephaly]] (enlargement of the head), particularly in children<ref name="azguide">Barker RA, Scolding N, Rowe D, Larner AJ. ''The A-Z of Neurological Practice: A Guide to Clinical Neurology'' [[Cambridge University Press]] 2005 Jan 10, p61. ({{ISBN|0-521-62960-8}})</ref>
*Cysts in the suprasellar region in children have presented as bobbing and nodding of the head called [[bobble-head doll syndrome]].<ref name="azguide" />
*Cysts in the suprasellar region in children have presented as bobbing and nodding of the head called [[bobble-head doll syndrome]].<ref name="azguide" />
*Cysts in the left middle cranial fossa have been associated with [[ADHD]] in a study on affected children.<ref>Millichap JG. "Temporal lobe arachnoid cyst-attention deficit disorder syndrome: role of the electroencephalogram in diagnosis", ''Neurology'' 1997 May;48(5):1435-9. ({{PMID|9153486}})</ref>
*Cysts in the left middle cranial fossa have been associated with [[ADHD]] in a study on affected children.<ref name="pmid9153486">{{cite journal | vauthors = Millichap JG | title = Temporal lobe arachnoid cyst-attention deficit disorder syndrome: role of the electroencephalogram in diagnosis | journal = Neurology | volume = 48 | issue = 5 | pages = 1435–9 | date = May 1997 | pmid = 9153486 }}</ref>
*[[Headache]]s.<ref name="ninds" /> A patient experiencing a headache does not necessarily have an arachnoid cyst.
*[[Headache]]s.<ref name="ninds" /> A patient experiencing a headache does not necessarily have an arachnoid cyst.
**In a 2002 study involving 78 patients with a migraine or tension-type headache, CT scans showed abnormalities in over a third of the patients, though arachnoid cysts only accounted for 2.6% of patients in this study.<ref>Valença MM, Valença LP, Menezes TL. "Computed tomography scan of the head in patients with migraine or tension-type headache", ''Arq Neuropsiquiatr.'' 2002 Sep;60(3-A):542-7. ({{PMID|12244387}})</ref>
**In a 2002 study involving 78 patients with a migraine or tension-type headache, CT scans showed abnormalities in over a third of the patients, though arachnoid cysts only accounted for 2.6% of patients in this study.<ref>Valença MM, Valença LP, Menezes TL. "Computed tomography scan of the head in patients with migraine or tension-type headache", ''Arq Neuropsiquiatr.'' 2002 Sep;60(3-A):542-7. ({{PMID|12244387}})</ref>
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*[[Hemiparesis]] (weakness or paralysis on one side of the body)<ref name="ninds" />
*[[Hemiparesis]] (weakness or paralysis on one side of the body)<ref name="ninds" />
*[[Ataxia]] (lack of muscle control)<ref name="ninds" />
*[[Ataxia]] (lack of muscle control)<ref name="ninds" />
*Musical [[hallucination]]<ref>Griffiths TD. "Musical hallucinosis in acquired deafness. Phenomenology and brain substrate.", ''Brain'', 2000 Oct;123 ( Pt 10):2065-76. ({{PMID|11004124}})</ref>
*Musical [[hallucination]]<ref name="pmid11004124">{{cite journal | vauthors = Griffiths TD | title = Musical hallucinosis in acquired deafness. Phenomenology and brain substrate | journal = Brain | volume = 123 ( Pt 10) | issue = | pages = 2065–76 | date = October 2000 | pmid = 11004124 }}</ref>
*Pre-senile [[dementia]],<ref name="dementia">Richards G, Lusznat RM. "An arachnoid cyst in a patient with pre-senile dementia", ''Progress in Neurology and Psychiatry'', 2001 May–June;5(3) [http://www.escriber.com/Progress/Features.asp?Action=View&Archive=True&ID=29&GroupID=&Page=18 http://www.escriber.com/Progress/Features.asp? Action=View&Archive=True&ID=29&GroupID=&Page=18] {{webarchive |url=https://web.archive.org/web/20070928042438/http://www.escriber.com/Progress/Features.asp?Action=View&Archive=True&ID=29&GroupID=&Page=18 |date=September 28, 2007 }}</ref> a condition often associated with [[Alzheimer's disease]]
*Pre-senile [[dementia]],<ref name="dementia">Richards G, Lusznat RM. "An arachnoid cyst in a patient with pre-senile dementia", ''Progress in Neurology and Psychiatry'', 2001 May–June;5(3) [http://www.escriber.com/Progress/Features.asp?Action=View&Archive=True&ID=29&GroupID=&Page=18 http://www.escriber.com/Progress/Features.asp? Action=View&Archive=True&ID=29&GroupID=&Page=18] {{webarchive |url=https://web.archive.org/web/20070928042438/http://www.escriber.com/Progress/Features.asp?Action=View&Archive=True&ID=29&GroupID=&Page=18 |date=September 28, 2007 }}</ref> a condition often associated with [[Alzheimer's disease]]
*In elderly patients (>80 years old) symptoms were similar to chronic [[subdural hematoma]] or normal pressure [[hydrocephalus]]:<ref name="eld">Yamakawa H, Ohkuma A, Hattori T, Niikawa S, Kobayashi H. "Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases", ''Acta Neurochir (Wien).'' 1991;113(1-2):42-7. ({{PMID|1799142}})</ref>
*In elderly patients (>80 years old) symptoms were similar to chronic [[subdural hematoma]] or normal pressure [[hydrocephalus]]:<ref name="eld">Yamakawa H, Ohkuma A, Hattori T, Niikawa S, Kobayashi H. "Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases", ''Acta Neurochir (Wien).'' 1991;113(1-2):42-7. ({{PMID|1799142}})</ref>
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===Location-specific symptoms===
===Location-specific symptoms===


*A [[supratentorial]] arachnoid cyst can mimic a [[Ménière's disease]] attack.<ref>Buongiorno G, Ricca G. "Supratentorial arachnoid cyst mimicking a Ménière's disease attack", ''J Laryngol Otol.'' 2003 Sep;117(9):728-30. ({{PMID|14561365}})</ref>
*A [[supratentorial]] arachnoid cyst can mimic a [[Ménière's disease]] attack.<ref name="pmid14561365">{{cite journal | vauthors = Buongiorno G, Ricca G | title = Supratentorial arachnoid cyst mimicking a Ménière's disease attack | journal = J Laryngol Otol | volume = 117 | issue = 9 | pages = 728–30 | date = September 2003 | pmid = 14561365 | doi = 10.1258/002221503322334602 }}</ref>
*Frontal arachnoid cysts have been associated with depression.<ref name="nbn">Cummings JL, Mega MS. ''Neuropsychiatry and Behavioral Neuroscience'', Oxford University Press, USA; 2Rev Ed, 2003 Jan 23;208. ({{ISBN|0-19-513858-9}})</ref>
*Frontal arachnoid cysts have been associated with depression.<ref name="nbn">Cummings JL, Mega MS. ''Neuropsychiatry and Behavioral Neuroscience'', Oxford University Press, USA; 2Rev Ed, 2003 Jan 23;208. ({{ISBN|0-19-513858-9}})</ref>
*Cysts on the left temporal lobe have been associated with [[psychosis]]. However this remains controversial and subjective to the individual clinician.<ref>Alves da Silva J, Alves A, Talina M, Carreiro S, Guimarães J, Xavier M. "Arachnoid cyst in a patient with psychosis: a case report" ''Annals of General Psychiatry'' 2007, 6:16 [http://www.annals-general-psychiatry.com/content/6/1/16]</ref><ref>Vakis AF, Koutentakis DI, Karabetsos DA, Kalostos GN. "Psychosis-like syndrome associated with intermittent intracranial hypertension caused by a large arachnoid cyst of the left temporal lobe", ''Br J Neurosurg.'' 2006 Jun;20(3):156-9. ({{PMID|16801049}})</ref> A left fronto-temporal cyst more specifically showed symptoms of [[alexithymia]].<ref>Blackshaw S, Bowen RC. "A case of atypical psychosis associated with alexithymia and a left fronto-temporal lesion: possible correlations", ''Can J Psychiatry'' 1987 Nov;32(8):688-92. ({{PMID|3690485}})</ref>
*Cysts on the left temporal lobe have been associated with [[psychosis]]. However this remains controversial and subjective to the individual clinician.<ref>Alves da Silva J, Alves A, Talina M, Carreiro S, Guimarães J, Xavier M. "Arachnoid cyst in a patient with psychosis: a case report" ''Annals of General Psychiatry'' 2007, 6:16 [http://www.annals-general-psychiatry.com/content/6/1/16]</ref><ref>Vakis AF, Koutentakis DI, Karabetsos DA, Kalostos GN. "Psychosis-like syndrome associated with intermittent intracranial hypertension caused by a large arachnoid cyst of the left temporal lobe", ''Br J Neurosurg.'' 2006 Jun;20(3):156-9. ({{PMID|16801049}})</ref> A left fronto-temporal cyst more specifically showed symptoms of [[alexithymia]].<ref name="pmid3690485">{{cite journal | vauthors = Blackshaw S, Bowen RC | title = A case of atypical psychosis associated with alexithymia and a left fronto-temporal lesion: possible correlations | journal = Can J Psychiatry | volume = 32 | issue = 8 | pages = 688–92 | date = November 1987 | pmid = 3690485 }}</ref>
*Cyst on the right [[sylvian fissure]] resulted in new onset of [[schizophrenia]]-like symptoms at age 61.<ref>Cullum CM, Heaton RK, Harris MJ, Jeste DV. "Neurobehavioral and neurodiagnostic aspects of late-onset psychosis", ''Arch Clin Neuropsychol.'' 1994 Oct;9(5):371-82. ({{PMID|14589653}})</ref>
*Cyst on the right [[sylvian fissure]] resulted in new onset of [[schizophrenia]]-like symptoms at age 61.<ref name="pmid14589653">{{cite journal | vauthors = Cullum CM, Heaton RK, Harris MJ, Jeste DV | title = Neurobehavioral and neurodiagnostic aspects of late-onset psychosis | journal = Arch Clin Neuropsychol | volume = 9 | issue = 5 | pages = 371–82 | date = October 1994 | pmid = 14589653 }}</ref>
*A patient with a cyst on the left [[middle cranial fossa]] had [[auditory system|auditory]] [[hallucinations]], [[migraine]]-like headaches, and periodic [[paranoia]]<ref name="cameronad" />
*A patient with a cyst on the left [[middle cranial fossa]] had [[auditory system|auditory]] [[hallucinations]], [[migraine]]-like headaches, and periodic [[paranoia]]<ref name="cameronad" />
*Patients with left temporal lobe cysts had mood disturbances similar to [[manic depression]] (bipolar disorder) and were known to show outward aggression<ref>Heinrichs, RW. ''In Search of Madness: Schizophrenia and Neuroscience'' Oxford University Press, USA (March 29, 2001); p129. ({{ISBN|0-19-512219-4}})</ref>
*Patients with left temporal lobe cysts had mood disturbances similar to [[manic depression]] (bipolar disorder) and were known to show outward aggression<ref>Heinrichs, RW. ''In Search of Madness: Schizophrenia and Neuroscience'' Oxford University Press, USA (March 29, 2001); p129. ({{ISBN|0-19-512219-4}})</ref>
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In some cases, arachnoid cysts occurring in the middle fossa are accompanied by underdevelopment ([[hypoplasia]]) or compression of the [[temporal lobe]]. The exact role that temporal lobe abnormalities play in the development of [[middle fossa]] arachnoid cysts is unknown.
In some cases, arachnoid cysts occurring in the middle fossa are accompanied by underdevelopment ([[hypoplasia]]) or compression of the [[temporal lobe]]. The exact role that temporal lobe abnormalities play in the development of [[middle fossa]] arachnoid cysts is unknown.


There are some cases where hereditary disorders have been connected with arachnoid cysts.<ref>Schievink WI, Huston J 3rd, Torres VE, Marsh WR. "Intracranial cysts in autosomal dominant polycystic kidney disease" ''J Neurosurg'' 1995 Dec;83(6):1004-7. ({{PMID|7490613}})</ref>
There are some cases where hereditary disorders have been connected with arachnoid cysts.<ref name="pmid7490613">{{cite journal | vauthors = Schievink WI, Huston J, Torres VE, Marsh WR | title = Intracranial cysts in autosomal dominant polycystic kidney disease | journal = J. Neurosurg. | volume = 83 | issue = 6 | pages = 1004–7 | date = December 1995 | pmid = 7490613 | doi = 10.3171/jns.1995.83.6.1004 }}</ref>


Some complications of arachnoid cysts can occur when a cyst is damaged because of minor [[head trauma]].<ref> [{{PMID|12101165}}] [PMC1725893] Haemorrhage into an arachnoid cyst: a serious complication of minor head trauma.</ref> Trauma can cause the fluid within a cyst to leak into other areas (e.g., [[subarachnoid space]]). Blood vessels on the surface of a cyst may tear and bleed into the cyst (intracystic [[hemorrhage]]), increasing its size. If a blood vessel bleeds on the outside of a cyst, a collection of blood ([[hematoma]]) may result. In the cases of intracystic hemorrhage and hematoma, the individual may have symptoms of increased pressure within the cranium and signs of compression of nearby nerve (neural) tissue.
Some complications of arachnoid cysts can occur when a cyst is damaged because of minor [[head trauma]].<ref name="pmid12101165">{{cite journal | vauthors = De K, Berry K, Denniston S | title = Haemorrhage into an arachnoid cyst: a serious complication of minor head trauma | journal = Emerg Med J | volume = 19 | issue = 4 | pages = 365–6 | date = July 2002 | pmid = 12101165 | pmc = 1725893 }}</ref> Trauma can cause the fluid within a cyst to leak into other areas (e.g., [[subarachnoid space]]). Blood vessels on the surface of a cyst may tear and bleed into the cyst (intracystic [[hemorrhage]]), increasing its size. If a blood vessel bleeds on the outside of a cyst, a collection of blood ([[hematoma]]) may result. In the cases of intracystic hemorrhage and hematoma, the individual may have symptoms of increased pressure within the cranium and signs of compression of nearby nerve (neural) tissue.


Some scientists debate whether arachnoid cysts are a true congenite condition or if this should be separated from secondary cysts.<ref>Westermaier T, Schweitzer T, Ernestus RI. "Arachnoid cysts" ''Adv Exp Med Biol'' 2012 724:37-50. ({{PMID|22411232}})</ref> A recent study shows differences in communication between the arachnoid cyst and the subarachnoid space by CT cisternography
Some scientists debate whether arachnoid cysts are a true congenite condition or if this should be separated from secondary cysts.<ref name="pmid22411232">{{cite journal | vauthors = Westermaier T, Schweitzer T, Ernestus RI | title = Arachnoid cysts | journal = Adv. Exp. Med. Biol. | volume = 724 | issue = | pages = 37–50 | date = 2012 | pmid = 22411232 | doi = 10.1007/978-1-4614-0653-2_3 |}}</ref> A recent study shows differences in communication between the arachnoid cyst and the subarachnoid space by CT cisternography
.<ref>Wang X, Chen JX, You C, Jiang S, "CT cisternography in intracranial symptomatic arachnoid cysts: classification and treatment" ''J Neurol Sci'' 2012 Jul 15;318(1-2):125-30. ({{PMID|22520095}})</ref> A comparison of arachnoid cyst fluid and CSF in a series of patients show differences in chemical composition.<ref>Berle M, Wester KG, Ulvik RJ, Kroksveen AC, Haaland OA, Amiry-Moghaddam M, Berven FS, Helland CA, "Arachnoid cysts do not contain cerebrospinal fluid: A comparative chemical analysis of arachnoid cyst fluid and cerebrospinal fluid in adults" ''Cerebrospinal Fluid Res'' 2010 Jun 10;7(1):8. ({{PMID|20537169}})</ref>
.<ref name="pmid22520095">{{cite journal | vauthors = Wang X, Chen JX, You C, Jiang S | title = CT cisternography in intracranial symptomatic arachnoid cysts: classification and treatment | journal = J. Neurol. Sci. | volume = 318 | issue = 1-2 | pages = 125–30 | date = July 2012 | pmid = 22520095 | doi = 10.1016/j.jns.2012.03.008 }}</ref> A comparison of arachnoid cyst fluid and CSF in a series of patients show differences in chemical composition.<ref name="pmid20537169">{{cite journal | vauthors = Berle M, Wester KG, Ulvik RJ, Kroksveen AC, Haaland OA, Amiry-Moghaddam M, Berven FS, Helland CA | title = Arachnoid cysts do not contain cerebrospinal fluid: A comparative chemical analysis of arachnoid cyst fluid and cerebrospinal fluid in adults | journal = Cerebrospinal Fluid Res | volume = 7 | issue = | pages = 8 | date = June 2010 | pmid = 20537169 | pmc = 2898803 | doi = 10.1186/1743-8454-7-8 }}</ref>


Arachnoid cysts can also occur secondary to other disorders such as [[Marfan syndrome]], [[arachnoiditis]], or [[agenesis of the corpus callosum]].
Arachnoid cysts can also occur secondary to other disorders such as [[Marfan syndrome]], [[arachnoiditis]], or [[agenesis of the corpus callosum]].
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Most arachnoid cysts are asymptomatic and do not require treatment. Treatment may be necessary when symptomatic.<ref name="ninds" /> A variety of procedures may be used to decompress (remove pressure from) the cyst.
Most arachnoid cysts are asymptomatic and do not require treatment. Treatment may be necessary when symptomatic.<ref name="ninds" /> A variety of procedures may be used to decompress (remove pressure from) the cyst.


*Surgical placement of a [[cerebral shunt]]:<ref>Strojnik T. "Different approaches to surgical treatment of arachnoid cysts", ''Wiener Klinische Wochenschrift.''[http://www.springerlink.com/content/f8j635026q64685h/] 2006;118 Suppl 2:85-8. ({{PMID|16817052}})</ref>
*Surgical placement of a [[cerebral shunt]]:<ref name="pmid16817052">{{cite journal | vauthors = Strojnik T | title = Different approaches to surgical treatment of arachnoid cysts | journal = Wien. Klin. Wochenschr. | volume = 118 Suppl 2 | issue = | pages = 85–8 | date = 2006 | pmid = 16817052 | doi = 10.1007/s00508-006-0540-2 }}</ref>
**An '''internal shunt''' drains into the subdural compartment.<ref>Helland CA, Wester K. "Arachnoid cysts in adults: long-term follow-up of patients treated with internal shunts to the subdural compartment", ''Surg Neurol.'' 2006 Jul;66(1):56-61; discussion 61. ({{PMID|16793443}})</ref>
**An '''internal shunt''' drains into the subdural compartment.<ref name="pmid16793443">{{cite journal | vauthors = Helland CA, Wester K | title = Arachnoid cysts in adults: long-term follow-up of patients treated with internal shunts to the subdural compartment | journal = Surg Neurol | volume = 66 | issue = 1 | pages = 56–61; discussion 61 | date = July 2006 | pmid = 16793443 | doi = 10.1016/j.surneu.2005.12.032 }}</ref>
**A '''cystoperitoneal shunt''' drains to the [[peritoneal cavity]].<ref>Park SW, Yoon SH, Cho KH, Shin YS. "A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern—case report", ''Surg Neurol'' 2006 Jun;65(6):611-14. ({{PMID|16720186}})</ref>
**A '''cystoperitoneal shunt''' drains to the [[peritoneal cavity]].<ref name="pmid16720186">{{cite journal | vauthors = Park SW, Yoon SH, Cho KH, Shin YS | title = A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern--case report | journal = Surg Neurol | volume = 65 | issue = 6 | pages = 611–4 | date = June 2006 | pmid = 16720186 | doi = 10.1016/j.surneu.2005.07.069 }}</ref>
*[[wikt:fenestration|Fenestration]]:
*[[wikt:fenestration|Fenestration]]:
**[[Craniotomy]] with [[surgery|excision]]<ref>Gangemi M, Colella G, Magro F, Maiuri F. "Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting", ''Br J Neurosurg'' 2007 Jun;21(3):276-80. ({{PMID|17612918}})</ref>
**[[Craniotomy]] with [[surgery|excision]]<ref name="pmid17612918">{{cite journal | vauthors = Gangemi M, Colella G, Magro F, Maiuri F | title = Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting | journal = Br J Neurosurg | volume = 21 | issue = 3 | pages = 276–80 | date = June 2007 | pmid = 17612918 | doi = 10.1080/02688690701339197 }}</ref>
**Various [[Endoscope|endoscopic]] techniques are proving effective,<ref>Greenfield JP, Souweidane MM. "Endoscopic management of intracranial cysts", ''Neurosurg Focus.'' 2005 Dec 15;19(6):E7. ({{PMID|16398484}})</ref> including laser-assisted techniques.<ref>Van Beijnum J, Hanlo PW, Han KS, Ludo Van der Pol W, Verdaasdonk RM, Van Nieuwenhuizen O. "Navigated laser-assisted endoscopic fenestration of a suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome", ''J Neurosurg.'' 2006 May;104(5 Suppl):348-51. ({{PMID|16848093}})</ref>
**Various [[Endoscope|endoscopic]] techniques are proving effective,<ref name="pmid16398484">{{cite journal | vauthors = Greenfield JP, Souweidane MM | title = Endoscopic management of intracranial cysts | journal = Neurosurg Focus | volume = 19 | issue = 6 | pages = E7 | date = December 2005 | pmid = 16398484 }}</ref> including laser-assisted techniques.<ref name="pmid16848093">{{cite journal | vauthors = Van Beijnum J, Hanlo PW, Han KS, Ludo Van der Pol W, Verdaasdonk RM, Van Nieuwenhuizen O | title = Navigated laser-assisted endoscopic fenestration of a suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome. Case report | journal = J. Neurosurg. | volume = 104 | issue = 5 Suppl | pages = 348–51 | date = May 2006 | pmid = 16848093 | doi = 10.3171/ped.2006.104.5.348 }}</ref>
*Drainage by [[needle aspiration]] or [[burr hole]].
*Drainage by [[needle aspiration]] or [[burr hole]].
*Capsular resection<ref name="eld" />
*Capsular resection<ref name="eld" />
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More specific prognoses are listed below:
More specific prognoses are listed below:
*Patients with impaired preoperative [[cognition]] had postoperative improvement after surgical decompression of the cyst.<ref>Wester K, Hugdahl K. "Arachnoid cysts of the left temporal fossa: impaired preoperative cognition and postoperative improvement." ''J Neurol Neurosurg Psychiatry'' 1995 Sep;59(3):293-8. ({{PMID|7673959}})</ref><ref>Wester K. "Intracranial arachnoid cysts--do they impair mental functions?" ''J Neurol'' 2008 Aug;255(8):1113-20. ({{PMID|18677648}})</ref>
*Patients with impaired preoperative [[cognition]] had postoperative improvement after surgical decompression of the cyst.<ref name="pmid7673959">{{cite journal | vauthors = Wester K, Hugdahl K | title = Arachnoid cysts of the left temporal fossa: impaired preoperative cognition and postoperative improvement | journal = J. Neurol. Neurosurg. Psychiatry | volume = 59 | issue = 3 | pages = 293–8 | date = September 1995 | pmid = 7673959 | pmc = 486033 }}</ref><ref name="pmid18677648">{{cite journal | vauthors = Wester K | title = Intracranial arachnoid cysts--do they impair mental functions? | journal = J. Neurol. | volume = 255 | issue = 8 | pages = 1113–20 | date = August 2008 | pmid = 18677648 | doi = 10.1007/s00415-008-0011-y }}</ref>
*Surgery can resolve psychiatric manifestations in selected cases.<ref>Kohn R, Lilly RB, Sokol MS, Malloy PF. "Psychiatric presentations of intracranial cysts", ''J Neuropsychiatry Clin Neurosci'' 1989; 1:60-66. ({{PMID|2577719}})</ref>
*Surgery can resolve psychiatric manifestations in selected cases.<ref name="pmid2577719">{{cite journal | vauthors = Kohn R, Lilly RB, Sokol MS, Malloy PF | title = Psychiatric presentations of intracranial cysts | journal = J Neuropsychiatry Clin Neurosci | volume = 1 | issue = 1 | pages = 60–6 | date = 1989 | pmid = 2577719 | doi = 10.1176/jnp.1.1.60 }}</ref>


==Epidemiology==
==Epidemiology==
Arachnoid cysts are seen in up to 1.1% of the population<ref name="MassNeur">Flaherty AW. ''The Massachusetts General Hospital Handbook of Neurology'' 2000 Jan 1;105. ({{ISBN|0-683-30576-X}})</ref><ref>Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A. "Incidental findings on brain MRI in the general population" 'N Engl J Med'' 2007 Nov 1;357(18):1821-8. ({{PMID|17978290}})</ref> with a gender distribution of 2:1 male:female <ref>Pradilla G, Jallo G. "Arachnoid cysts: case series and review of the literature" 'Neurosurg Focus'' 2007 Feb 15;22(2):E7. ({{PMID|17608350}})</ref> Only 20% of these have symptoms, usually from secondary [[hydrocephalus]].<ref name="MassNeur" />
Arachnoid cysts are seen in up to 1.1% of the population<ref name="MassNeur">Flaherty AW. ''The Massachusetts General Hospital Handbook of Neurology'' 2000 Jan 1;105. ({{ISBN|0-683-30576-X}})</ref><ref name="pmid17978290">{{cite journal | vauthors = Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A | title = Incidental findings on brain MRI in the general population | journal = N. Engl. J. Med. | volume = 357 | issue = 18 | pages = 1821–8 | date = November 2007 | pmid = 17978290 | doi = 10.1056/NEJMoa070972 }}</ref> with a gender distribution of 2:1 male:female.<ref name="pmid17608350">{{cite journal | vauthors = Pradilla G, Jallo G | title = Arachnoid cysts: case series and review of the literature | journal = Neurosurg Focus | volume = 22 | issue = 2 | pages = E7 | date = February 2007 | pmid = 17608350 }}</ref> Only 20% of these have symptoms, usually from secondary [[hydrocephalus]].<ref name="MassNeur" />


A study that looked at 2,536 healthy young males found a prevalence of 1.7% (95% [[Confidence interval|CI]] 1.2 to 2.3%). Only a small percentage of the detected abnormalities require urgent medical attention.<ref name="nmn">Weber F, Knopf H. "Incidental findings in magnetic resonance imaging of the brains of healthy young men", ''J Neurol Sci.'' 2006 Jan 15;240(1-2):81-4. Epub 2005 Oct 26. ({{PMID|16256141}})</ref>
A study that looked at 2,536 healthy young males found a prevalence of 1.7% (95% [[Confidence interval|CI]] 1.2 to 2.3%). Only a small percentage of the detected abnormalities require urgent medical attention.<ref name="pmid16256141">{{cite journal | vauthors = Weber F, Knopf H | title = Incidental findings in magnetic resonance imaging of the brains of healthy young men | journal = J. Neurol. Sci. | volume = 240 | issue = 1-2 | pages = 81–4 | date = January 2006 | pmid = 16256141 | doi = 10.1016/j.jns.2005.09.008 }}</ref>


==See also==
==See also==

Revision as of 21:02, 30 August 2018

Arachnoid cyst
An MRI of a 25-year-old woman with left frontotemporal arachnoid cyst.
SpecialtyNeurosurgery Edit this on Wikidata

Arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen[1] that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three meningeal layers that cover the brain and the spinal cord.[2] Arachnoid cysts are a congenital disorder,[3] and most cases begin during infancy; however, onset may be delayed until adolescence.[2]

Classification

Arachnoid cysts can be found on the brain or on the spine. Intracranial arachnoid cysts usually occur adjacent to the arachnoidal cistern.[4] Spinal arachnoid cysts may be extradural, intradural, or perineural and tend to present with signs and symptoms indicative of a radiculopathy.[4]

Arachnoid cysts may also be classified as primary (congenital) or secondary (acquired) and have been reported in humans, cats, and dogs.[5]

Arachnoid cysts can be relatively asymptomatic or present with insidious symptoms; for this reason, diagnosis is often delayed.

Signs and symptoms

Patients with arachnoid cysts may never show symptoms, even in some cases where the cyst is large. Therefore, while the presence of symptoms may provoke further clinical investigation, symptoms independent of further data cannot—and should not—be interpreted as evidence of a cyst's existence, size, location, or potential functional impact on the patient.

Symptoms vary by the size and location of the cyst(s), though small cysts usually have no symptoms and are discovered only incidentally.[2] On the other hand, a number of symptoms may result from large cysts:

  • Cranial deformation or macrocephaly (enlargement of the head), particularly in children[6]
  • Cysts in the suprasellar region in children have presented as bobbing and nodding of the head called bobble-head doll syndrome.[6]
  • Cysts in the left middle cranial fossa have been associated with ADHD in a study on affected children.[7]
  • Headaches.[2] A patient experiencing a headache does not necessarily have an arachnoid cyst.
    • In a 2002 study involving 78 patients with a migraine or tension-type headache, CT scans showed abnormalities in over a third of the patients, though arachnoid cysts only accounted for 2.6% of patients in this study.[8]
    • A study found 18% of patients with intracranial arachnoid cysts had non-specific headaches. The cyst was in the temporal location in 75% of these cases.[9]
  • Seizures[2]
  • Hydrocephalus (excessive accumulation of cerebrospinal fluid)[2]
  • Increased intracranial pressure[2]
  • Developmental delay[2]
  • Behavioral changes[2]
  • Nausea
  • Hemiparesis (weakness or paralysis on one side of the body)[2]
  • Ataxia (lack of muscle control)[2]
  • Musical hallucination[10]
  • Pre-senile dementia,[11] a condition often associated with Alzheimer's disease
  • In elderly patients (>80 years old) symptoms were similar to chronic subdural hematoma or normal pressure hydrocephalus:[12]

Location-specific symptoms

Causes

The exact cause of arachnoid cysts is not known. Researchers believe that most cases of arachnoid cysts are developmental malformations that arise from the unexplained splitting or tearing of the arachnoid membrane.

In some cases, arachnoid cysts occurring in the middle fossa are accompanied by underdevelopment (hypoplasia) or compression of the temporal lobe. The exact role that temporal lobe abnormalities play in the development of middle fossa arachnoid cysts is unknown.

There are some cases where hereditary disorders have been connected with arachnoid cysts.[20]

Some complications of arachnoid cysts can occur when a cyst is damaged because of minor head trauma.[21] Trauma can cause the fluid within a cyst to leak into other areas (e.g., subarachnoid space). Blood vessels on the surface of a cyst may tear and bleed into the cyst (intracystic hemorrhage), increasing its size. If a blood vessel bleeds on the outside of a cyst, a collection of blood (hematoma) may result. In the cases of intracystic hemorrhage and hematoma, the individual may have symptoms of increased pressure within the cranium and signs of compression of nearby nerve (neural) tissue.

Some scientists debate whether arachnoid cysts are a true congenite condition or if this should be separated from secondary cysts.[22] A recent study shows differences in communication between the arachnoid cyst and the subarachnoid space by CT cisternography .[23] A comparison of arachnoid cyst fluid and CSF in a series of patients show differences in chemical composition.[24]

Arachnoid cysts can also occur secondary to other disorders such as Marfan syndrome, arachnoiditis, or agenesis of the corpus callosum.

Diagnosis

Arachnoid cyst as seen on a CT image of the brain
Axial CT showing a typical arachnoid cyst left temporal

Diagnosis is principally by MRI. Frequently, arachnoid cysts are incidental findings on MRI scans performed for other clinical reasons. In practice, diagnosis of symptomatic arachnoid cysts requires symptoms to be present, and many with the disorder never develop symptoms.

Additional clinical assessment tools that can be useful in evaluating a patient with arachnoid cysts include the mini-mental state examination (MMSE), a brief questionnaire-based test used to assess cognition.[11]

Treatment/Management

Most arachnoid cysts are asymptomatic and do not require treatment. Treatment may be necessary when symptomatic.[2] A variety of procedures may be used to decompress (remove pressure from) the cyst.

Prognosis

Most arachnoid cysts are asymptomatic, and do not require treatment. Where complications are present, leaving arachnoid cysts untreated may cause permanent severe neurological damage due to the progressive expansion of the cyst(s) or hemorrhage (bleeding).[2] However, with treatment most individuals with symptomatic arachnoid cysts do well.

More specific prognoses are listed below:

  • Patients with impaired preoperative cognition had postoperative improvement after surgical decompression of the cyst.[31][32]
  • Surgery can resolve psychiatric manifestations in selected cases.[33]

Epidemiology

Arachnoid cysts are seen in up to 1.1% of the population[34][35] with a gender distribution of 2:1 male:female.[36] Only 20% of these have symptoms, usually from secondary hydrocephalus.[34]

A study that looked at 2,536 healthy young males found a prevalence of 1.7% (95% CI 1.2 to 2.3%). Only a small percentage of the detected abnormalities require urgent medical attention.[37]

See also

References

  1. ^ Ariai S, Koerbel A, Bornemann A, Morgala M, Tatagiba M (2005). "Cerebellopontine angle arachnoid cyst harbouring ectopic neuroglia". Pediatr Neurosurg. 41 (4): 220–3. doi:10.1159/000086566. PMID 16088260.
  2. ^ a b c d e f g h i j k l m "Arachnoid Cysts Information Page". NINDS. Retrieved April 7, 2017.
  3. ^ Gelabert-González M (2004). "Intracranial arachnoid cysts]". Rev Neurol (in Spanish). 39 (12): 1161–6. PMID 15625636.
  4. ^ a b Arachnoid cyst. (n.d.). Gale Encyclopedia of Neurological Disorders. Retrieved September 10, 2006, from Answers.com Web site: http://www.answers.com/topic/arachnoid-cyst
  5. ^ Reed SD, Cho DY, Paulsen D. Quadrigeminal Arachnoid Cysts in a kitten and a dog. J Vet Diagn Invest 2009. 21(5):707-710.
  6. ^ a b Barker RA, Scolding N, Rowe D, Larner AJ. The A-Z of Neurological Practice: A Guide to Clinical Neurology Cambridge University Press 2005 Jan 10, p61. (ISBN 0-521-62960-8)
  7. ^ Millichap JG (May 1997). "Temporal lobe arachnoid cyst-attention deficit disorder syndrome: role of the electroencephalogram in diagnosis". Neurology. 48 (5): 1435–9. PMID 9153486.
  8. ^ Valença MM, Valença LP, Menezes TL. "Computed tomography scan of the head in patients with migraine or tension-type headache", Arq Neuropsiquiatr. 2002 Sep;60(3-A):542-7. (PMID 12244387)
  9. ^ a b Cameron AD. "Psychotic phenomena with migraine and an arachnoid cyst", Progress in Neurology and Psychiatry 2002 Mar-Apr 6(2) http://www.escriber.com/Progress/Features.asp? Action=View&Archive=True&ID=67&GroupID=&Page=11 Archived September 28, 2007, at the Wayback Machine
  10. ^ Griffiths TD (October 2000). "Musical hallucinosis in acquired deafness. Phenomenology and brain substrate". Brain. 123 ( Pt 10): 2065–76. PMID 11004124.
  11. ^ a b Richards G, Lusznat RM. "An arachnoid cyst in a patient with pre-senile dementia", Progress in Neurology and Psychiatry, 2001 May–June;5(3) http://www.escriber.com/Progress/Features.asp? Action=View&Archive=True&ID=29&GroupID=&Page=18 Archived September 28, 2007, at the Wayback Machine
  12. ^ a b Yamakawa H, Ohkuma A, Hattori T, Niikawa S, Kobayashi H. "Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases", Acta Neurochir (Wien). 1991;113(1-2):42-7. (PMID 1799142)
  13. ^ Buongiorno G, Ricca G (September 2003). "Supratentorial arachnoid cyst mimicking a Ménière's disease attack". J Laryngol Otol. 117 (9): 728–30. doi:10.1258/002221503322334602. PMID 14561365.
  14. ^ Cummings JL, Mega MS. Neuropsychiatry and Behavioral Neuroscience, Oxford University Press, USA; 2Rev Ed, 2003 Jan 23;208. (ISBN 0-19-513858-9)
  15. ^ Alves da Silva J, Alves A, Talina M, Carreiro S, Guimarães J, Xavier M. "Arachnoid cyst in a patient with psychosis: a case report" Annals of General Psychiatry 2007, 6:16 [1]
  16. ^ Vakis AF, Koutentakis DI, Karabetsos DA, Kalostos GN. "Psychosis-like syndrome associated with intermittent intracranial hypertension caused by a large arachnoid cyst of the left temporal lobe", Br J Neurosurg. 2006 Jun;20(3):156-9. (PMID 16801049)
  17. ^ Blackshaw S, Bowen RC (November 1987). "A case of atypical psychosis associated with alexithymia and a left fronto-temporal lesion: possible correlations". Can J Psychiatry. 32 (8): 688–92. PMID 3690485.
  18. ^ Cullum CM, Heaton RK, Harris MJ, Jeste DV (October 1994). "Neurobehavioral and neurodiagnostic aspects of late-onset psychosis". Arch Clin Neuropsychol. 9 (5): 371–82. PMID 14589653.
  19. ^ Heinrichs, RW. In Search of Madness: Schizophrenia and Neuroscience Oxford University Press, USA (March 29, 2001); p129. (ISBN 0-19-512219-4)
  20. ^ Schievink WI, Huston J, Torres VE, Marsh WR (December 1995). "Intracranial cysts in autosomal dominant polycystic kidney disease". J. Neurosurg. 83 (6): 1004–7. doi:10.3171/jns.1995.83.6.1004. PMID 7490613.
  21. ^ De K, Berry K, Denniston S (July 2002). "Haemorrhage into an arachnoid cyst: a serious complication of minor head trauma". Emerg Med J. 19 (4): 365–6. PMC 1725893. PMID 12101165.
  22. ^ Westermaier T, Schweitzer T, Ernestus RI (2012). "Arachnoid cysts". Adv. Exp. Med. Biol. 724: 37–50. doi:10.1007/978-1-4614-0653-2_3. PMID 22411232. {{cite journal}}: Cite has empty unknown parameter: |1= (help)
  23. ^ Wang X, Chen JX, You C, Jiang S (July 2012). "CT cisternography in intracranial symptomatic arachnoid cysts: classification and treatment". J. Neurol. Sci. 318 (1–2): 125–30. doi:10.1016/j.jns.2012.03.008. PMID 22520095.
  24. ^ Berle M, Wester KG, Ulvik RJ, Kroksveen AC, Haaland OA, Amiry-Moghaddam M, Berven FS, Helland CA (June 2010). "Arachnoid cysts do not contain cerebrospinal fluid: A comparative chemical analysis of arachnoid cyst fluid and cerebrospinal fluid in adults". Cerebrospinal Fluid Res. 7: 8. doi:10.1186/1743-8454-7-8. PMC 2898803. PMID 20537169.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  25. ^ Strojnik T (2006). "Different approaches to surgical treatment of arachnoid cysts". Wien. Klin. Wochenschr. 118 Suppl 2: 85–8. doi:10.1007/s00508-006-0540-2. PMID 16817052.
  26. ^ Helland CA, Wester K (July 2006). "Arachnoid cysts in adults: long-term follow-up of patients treated with internal shunts to the subdural compartment". Surg Neurol. 66 (1): 56–61, discussion 61. doi:10.1016/j.surneu.2005.12.032. PMID 16793443.
  27. ^ Park SW, Yoon SH, Cho KH, Shin YS (June 2006). "A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern--case report". Surg Neurol. 65 (6): 611–4. doi:10.1016/j.surneu.2005.07.069. PMID 16720186.
  28. ^ Gangemi M, Colella G, Magro F, Maiuri F (June 2007). "Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting". Br J Neurosurg. 21 (3): 276–80. doi:10.1080/02688690701339197. PMID 17612918.
  29. ^ Greenfield JP, Souweidane MM (December 2005). "Endoscopic management of intracranial cysts". Neurosurg Focus. 19 (6): E7. PMID 16398484.
  30. ^ Van Beijnum J, Hanlo PW, Han KS, Ludo Van der Pol W, Verdaasdonk RM, Van Nieuwenhuizen O (May 2006). "Navigated laser-assisted endoscopic fenestration of a suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome. Case report". J. Neurosurg. 104 (5 Suppl): 348–51. doi:10.3171/ped.2006.104.5.348. PMID 16848093.
  31. ^ Wester K, Hugdahl K (September 1995). "Arachnoid cysts of the left temporal fossa: impaired preoperative cognition and postoperative improvement". J. Neurol. Neurosurg. Psychiatry. 59 (3): 293–8. PMC 486033. PMID 7673959.
  32. ^ Wester K (August 2008). "Intracranial arachnoid cysts--do they impair mental functions?". J. Neurol. 255 (8): 1113–20. doi:10.1007/s00415-008-0011-y. PMID 18677648.
  33. ^ Kohn R, Lilly RB, Sokol MS, Malloy PF (1989). "Psychiatric presentations of intracranial cysts". J Neuropsychiatry Clin Neurosci. 1 (1): 60–6. doi:10.1176/jnp.1.1.60. PMID 2577719.
  34. ^ a b Flaherty AW. The Massachusetts General Hospital Handbook of Neurology 2000 Jan 1;105. (ISBN 0-683-30576-X)
  35. ^ Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (November 2007). "Incidental findings on brain MRI in the general population". N. Engl. J. Med. 357 (18): 1821–8. doi:10.1056/NEJMoa070972. PMID 17978290.
  36. ^ Pradilla G, Jallo G (February 2007). "Arachnoid cysts: case series and review of the literature". Neurosurg Focus. 22 (2): E7. PMID 17608350.
  37. ^ Weber F, Knopf H (January 2006). "Incidental findings in magnetic resonance imaging of the brains of healthy young men". J. Neurol. Sci. 240 (1–2): 81–4. doi:10.1016/j.jns.2005.09.008. PMID 16256141.

External links


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