The Effectiveness of Microsurgical Marsupialization and Fenestration Procedures in the Treatment of Symptomatic Intracranial Arachnoid Cysts

Background: Arachnoid cysts are benign congenital cysts that occur along the craniospinal axis. Itaccount for approximately 1% of intracranial lesions. There has been significant debate about theorigins as well as the optimal surgical management of arachnoid cysts. Objective: This study wassubjected to discuss the effectiveness of microsurgical marsuplization and fenestrationprocedures in the outcome of symptomatic cranial arachnoid cyst. Patients and Methods: Duringthe period from March 2012 to August 2014, twenty patients between 6 months and 10 yearsunderwent microscopic marsupialization and fenestration into basal cisterns with excision of thecyst wall for symptomatic cranial arachnoid cyst in the Neurosurgery Department, Al-MenoufiaUniversity with a follow up period up to 12 months post-operative. Results: In our study the mostcommon presentation was headache in fourteen patients (70%) followed by vomiting in eightpatients (40%), the most common cyst location was temporal in eleven patients (55%) followedby the infra- tentorial in four patients (20%). Satisfactory clinical outcome was observed in fitieenpatients (75%), while poor outcome was in only five patients (25%). The most commoncomplications were infection in three patients (15%) and transient cerebrospinal fluid (CSF)leakage in only one patient (5%). Conclusion: Management of intracranial arachnoid cyst remainscontroversial and most of the patients managed conservatively but we believe that once surgicaloption has been chosen it should be performed as early as possible .Selection of the surgicalmodality depends on proper evaluation, surgeon experience, socioeconomic level of the patientand his consent.