Aspiration and Drainage of Arachnoid Cysts

Abstract

An arachnoid cyst (AC) is a congenital benign non-neoplastic abnormality composed of arachnoid-related serous tissues. Patients with these abnormal cysts may present with a wide variety of symptoms depending on their location. Although often detected as an incidental finding in many patients, with no complaints at the time of diagnosis, a group of patients could be symptomatic due to increased intracranial pressure, hemorrhage, trauma, etc. Despite the extensive research on different aspects of ACs, the underlying pathology is not clearly defined yet. As the current therapeutic modalities, cyst aspiration and drainage by a needle via burr hole craniotomy and cystoperitoneal (CP) shunting may be helpful in select patients. The scant amount of data in terms of the optimal treatment has resulted in a multitude of suggested therapeutic approaches without level I of evidence. Accordingly, and as concurred in all suggested methods, precise patient selection would be crucial for achieving favorable outcomes. The application of CP shunting, as the primary treatment for ACs, is controversial, although some authors have highly recommended it only if indicated. The cyst aspiration and burr hole drainage are not extensively studied yet; therefore, this method is less popular with limited indications. Based on the literature, most of the current information on the treatment of ACs has been based on case reports and case series (evidence level—IV). Hence, further studies with a higher level of evidence are required to more precisely determine the optimal therapeutic modality for ACs in the future.