Arachnoid Cysts of the Middle Cranial Fossa: Experience with 77 Cases Treated Surgically

  • E. Galassi
  • G. Gaist
  • G. Giuliani
  • Eu. Pozzati
Part of the Acta Neurochirurgica Supplementum 42 book series (NEUROCHIRURGICA, volume 42)


Arachnoid cysts of the middle cranial fossa (Sylvian cysts), represent the most common type of intracranial leptomeningeal malformation. Among the 102 intracranial arachnoid cysts operated on at the authors’ institution from January 1970 to August 1986, the 77 cases (75%) located in the middle cranial fossa are reviewed. The higher incidence in the first two decades of life (51 cases) as well as the marked predilection for the male sex (60 cases) and the left hemisphere (55 cases) are confirmed in the authors’ experience. As for clinical presentation cranial deformities, symptoms of raised intracranial pressure and epilepsy constituted the most frequent features. In 13 patients a complicating lesion was associated: subdural or intracystic haematomas in 7 cases, subdural hygromas in 4 cases and, extradural haematomas in 2 cases. Based on the apperance at CT scan and the results at CT cisternography the authors proposed a classification into three basic types of increasing severity and different pathophysiologic conditions. All the patients underwent craniotomy, excision of the cyst walls and perforation into the basal cisterns. There was one postoperative death (mortality rate of 1.3%) due to meningitis. The remaining clinical results were gratifying in all three types of lesion; on follow-up CT scans the cysts of type I° and II° exhibited a steady tendency to reduction or obliteration while cerebral reexpansion seemed less evident in the third, most severe, type. The authors compare and discuss the options of radical open surgery versus shunting procedures.


Subdural Haematoma Arachnoid Cyst Basal Cistern Middle Cranial Fossa Sylvian Fissure 
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  1. 1.
    Auer LM, Gallhofer B, Ladurner G, Sager WD, Heppner F, Lechner H (1981) Diagnosis and treatment of middle fossa arachnoid cysts and subdural haematomas. J Neurosurg 54: 366–369.PubMedCrossRefGoogle Scholar
  2. 2.
    Bhandari YS (1972) Non-communicating supratentorial subarachnoid cysts. J Neurol Neurosurg Psychiatry 35: 763–770.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Dyck P, Gruskin P (1977) Supratentorial arachnoid cysts in adults. Arch Neurol 34: 276–279.PubMedCrossRefGoogle Scholar
  4. 4.
    Galassi E, Piazza G, Gaist G, Frank F (1980) Arachnoid cysts of the middle cranial fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 14: 211–219.PubMedGoogle Scholar
  5. 5.
    Galassi E, Tognetti F, Gaist G, Fagioli L, Frank F, Frank G (1982) CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol 17: 363–369.PubMedCrossRefGoogle Scholar
  6. 6.
    Galassi E, Tognetti F, Frank F, Fagioli L, Nasi MT, Gaist G (1985) Infratentorial arachnoid cysts. J Neurosurg 63: 210–217.PubMedCrossRefGoogle Scholar
  7. 7.
    Galassi E, Tognetti F, Pozzati E, Frank F (1986) Extradural haematoma complicating middle fossa arachnoid cyst. Child’s Nerv Syst 2: 306–308.CrossRefGoogle Scholar
  8. 8.
    Geissinger JD, Kohler WC, Robinson BW, Davis FM (1978) Arachnoid cysts of the middle cranial fossa. Surgical considerations. Surg Neurol 10: 27–33.PubMedGoogle Scholar
  9. 9.
    Ghatak NR, Mushrush GJ (1971) Supratentorial intra-arachnoid cysts. Case report. J Neurosurg 35: 477–482.PubMedCrossRefGoogle Scholar
  10. 10.
    Go KG, Houthoff HJ, Blaauw EH, Havinga P, Hartsuiker J (1984) Arachnoid cysts of the Sylvian fissure. Evidence of fluid secretion. J Neurosurg 60: 803–813.PubMedCrossRefGoogle Scholar
  11. 11.
    Harsh GR, Edwards MSB, Wilson CB (1986) Intracranial arachnoid cysts in children. J Neurosurg 64: 835–842.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaplan BJ, Mickle JP, Parkhurst R (1984) Cystoperitoneal shunting for congenital arachnoid cysts. Child’s Brain 11: 304–311.PubMedGoogle Scholar
  13. 13.
    Kato M, Nakada Y, Ariga N, Kokubo Y, Makino H (1980) Prognosis of primary middle fossa arachnoid cysts in children. Child’s Brain 7: 195–204.PubMedGoogle Scholar
  14. 14.
    La Cour F, Trevor R, Carey R (1978) Arachnoid cyst and associated subdural haematoma. Arch Neurol 35: 84–89.CrossRefGoogle Scholar
  15. 15.
    Naidich TP, McLone DG, Radkowski MA (1986) Intracranial arachnoid cysts. Pediat Neurosci 12: 112–122.CrossRefGoogle Scholar
  16. 16.
    Rengachary SS, Watanabe I (1981) Ultrastructure and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40: 61–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Robinson RG (1964) The temporal lobe agenesis syndrome. Brain 87: 87–106.PubMedCrossRefGoogle Scholar
  18. 18.
    Robinson RG (1971) Congenital cysts of the brain: arachnoid malformations. Progr Neurol Surg 4: 133–174.Google Scholar
  19. 19.
    Seur NH, Kooman A (1976) Arachnoid cyst of the middle fossa with paradoxical changes of the bony structures. Neuroradiology 12: 177–183.PubMedCrossRefGoogle Scholar
  20. 20.
    Smith RA, Smith WA (1976) Arachnoid cysts of the middle cranial fossa. Surg Neurol 5: 246–252.PubMedGoogle Scholar
  21. 21.
    Sprung CH, Mauersberger W (1979) Value of Computed Tomography for the diagnosis of arachnoid cysts and assessment of surgical treatment. Acta Neurochir (Wien) [Suppl] 28: 619–626.Google Scholar
  22. 22.
    Starkman SP, Brown TC, Linell EA (1958) Cerebral arachnoid cysts. J Neuropathol Exp Neurol 17: 484–500.PubMedCrossRefGoogle Scholar
  23. 23.
    Stein SC (1981) Intracranial developmental cysts in children: treatment by cystoperitoneal shunting. Neurosurgery 8: 647–650.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1988

Authors and Affiliations

  • E. Galassi
    • 1
  • G. Gaist
    • 1
  • G. Giuliani
    • 1
  • Eu. Pozzati
    • 1
  1. 1.Divisione di NeurochirurgiaBolognaItaly

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