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Abstract Arachnoid cysts (ACs) are benign congential cysts that occur along the craniospinal axis. [1] Arachnoid cysts account for approximately 1% of intracranial mass lesions.[2] There has been significant debate about the origins as well as the optimal surgical management of arachnoid cysts.[3] The common locations of ACs are the surface of the brain at the level of main brain fissures, such as sylvian, rolandic and interhemispheric fissures, sella turcica, the anterior cranial fossa, and the middle cranial fossa.[5] Most arachnoid cysts are found incidentally and can be managed conservatively.[7] Many authors recommend not treating arachnoid cysts that do not causes mass effect or symptoms, Regardless of their size and location.[8] Progressive growth of arachnoid cysts may cause secondary regional effects such as hypoplasia of the temporal lobe they may manifest with symptoms such as seizures, developmental delay, visual loss, or motor deficits. [9] Patients with arachnoid cysts may also present with hemorrhagic events, especially following head trauma.[10] Sports related head injuries occasionally cause subdural haematomas which may be the first presentation of a previously undiagnosed arachnoid cyst.[4] The optimal method of treatment for arachnoid cysts remains controversial. Shunting procedures, although simple, have been associated with infections, malfunctions and over-drainage.[11] The aim of this work was to study surgical modalities for management of intracranial arachnoid cysts regarding indication, outcome and complications. This retrospective study was conducted on 20 patients presented with intracranial arachnoid cyst managed in the department of Neurosurgery, Menoufia university hospital in the period from February 2010 to February 2012 with follow up for one year later. The patients were selected according to the following criteria: Inclusion criteria: 4. Symptomatic arachnoid cyst either clinical or radiological. 5. Age ranging from 6 months to 16 years old. 6. Medically fit patients. Exclusion criteria : 1.patient with history of previous surgery for management of arachnoid cyst . 2.Medically unfit patients. All patients underwent C T brain imaging before a decision was made about the surgical procedure. Twenty patients in the study were grouped into three groups: Group A: include seven patients and were operated by microscopic marspuialization and fenestration into basal cistern and excision of the cyst wall . Group B: include seven patients and were operated by endoscopic fenestration. Group C: include six patients and were operated by cysto peritoneal shunt. 1) The clinical outcome : according to 4 grades system ( clinical outcome groups (COGs)). • (COG1): the preoperative complaints had disappeared entirely or were negligible. • (COG2): the preoperative complaints were clearly reduced but still present . • (COG3): the preoperative complaints were unchanged . • (COG4):the patient had more complaints after operation. Patients in COG1 and COG 2 are considered satisfactory clinical outcome and patients in COG 3 and COG4 are considered poor clinical outcome.[89] 4) The radiological outcome: assessed by C T brain done in early post operative period and one year later at the end of the study . Patients were categorised into one of four possible radiological outcome groups (ROGs) • (ROG1): the cyst had disappeared and was no longer visible . • (ROG2): a fluid volume was still visible where the cyst had been smaller than 50% of the preoperative cyst volume . • (ROG3):as above, but the residual volume was larger than 50% of the preoperative cyst volume. • (ROG4): no change in cyst volume could be observed.[89] Patients in ROG1 and ROG 2 are considered good radiological outcome and patients in ROG 3 and ROG4 are considered poor radiological outcome. The study include 14 males and 6 females (2.3:1), which shows male predominance of 70 % of the cases. The age of the patients in this study ranged from 8 months to 14 years. The mean age was 5.07 years In our study the most common presentation was headache which was observed in 9 patients ( 45%) followed by vomiting which was observed in 7 patients ( 35%) In our study , the most common cyst location was the temporal in 11 patients (55%) . followed by the infra tentorial which was 4 patients ( 20 %), temproparietal in 2 patients ( 10 %) . In our study . patients were categorized into 4 clinical out come groups COG1 was 5 patients (25 %) , COG2 was 10 patients (5o%) , COG3 was 4 patients (20%) and COG 4 was 1 patient (5%). Patients with satisfactory clinical out come were 15 (75%). 6 patients from group A (85.7 %) of group A , 4 patients from group B (57.1 %) of group B and 5 patients from group C (83.3 %) of group C . Patients with poor clinical out come were 5 (25%). 1 patient from group A (14.3 %) of group A , 3patients from group B (42.9 %) of group B and 1 patient from group C (16.7 %) of group C . ROG1 was 2 patients (10 %) , ROG2 was 10 patients (50%) , ROG3 was 1 patient (5%) And ROG 4 was 7 patients (35%). Patients with good radiological out come were 12 (60%) . 6 patients from group A (85.7 %) of group A , 3 patients from group B (42.9 %) of group B and 3 patients from group C (50 %) of group C . Patients with poor radiological out come were 8 (40 %) . 1 patients from group A (14.3 %) of group A , 4 patients from group B (57.1 %) of group B and 3 patients from group C (50 %) of group C . In our study , 13 patients (65%) passed without complication while only 7 patients (35%)suffered from complications. Among the complicated patients , 3 patients were in group C ( 50%) of groub C , 3 patients were in in group B (42.9 ) of group B and only one patient from group A ( 14.3%) of group A. The most common complication occurred was infection which occurred in 2 patients both of them were in group C. |