Management of Symptomatic Middle Cranial Fossa (Sylvian) Arachnoid Cyst

Object Arachnoid cyst accounts for 1% of all intracranial lesions; middle cranial fossa (Sylvian) comprise ∼49% of all intracranial arachnoid cyst. Only symptomatic arachnoid cyst should be treated with cyst fenestration using endoscope or microscope and/or shunt placement. This study evaluates the role of fenestration and shunt placement in these patients.

Methods Eighteen pediatric patients with symptomatic middle cranial fossa (Sylvian) arachnoid cyst are the subject to this study. Cyst fenestration, either endoscopic or microscopic, was preformed first and shunt placement was required in the following cases: (1) manifestations of increase intracranial pressure; (2) CSF leak from the wound; (3) progressive increase in cyst size; and (4) subdural hygroma.

Results Three patients (16.6%) required shunt placement after cyst fenestration; younger age patients were noticed to need shunt placement after fenestration.

Conclusion Endoscopic or microscopic fenestration is a reliable procedure for treatment of symptomatic middle cranial fossa (Sylvian) arachnoid cyst except for younger patients where shunt placement will be a better option.

Keywords middle cranial fossa (Sylvian); shunt; fenestration; congenital