الفهرس 
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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.