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Arachnoid cysts of the middle cra nial fossa

K. von Wild
Neurochirurgische Abte ilung Clemenshos pttal. Akadem isches Lehrkr anke nhaus
der westr. wühefms-unrversüät Münster

Sum m ary Arac hnoidalzyste n de r mittl e ren

Schädelgru be
In 18 cas es of temporal arachnoid cysts the
etiology. clinical a nd radiographie ündtngs. surgical Die derzeitigen diagnostisc hen und neu -
treat ment. and outcome are reviewed . Cysts of the roch irurgischen Beha ndlungsmögliehkeiten von temp o-
middle erentel fossa are susceptible to trauma, which ralen Arac hnoidalzysten werden vor dem Hintergrund
may cause bleeding either Into the cyst or lnto the sub- gesicherter pathologisch-anatomis cher Kenntnisse an
dural space. er or MRI sean s are dta gnosdc in arach- typischen Beispiele n von 3 Kind ern und 15 Erwa ch -
noid cysts . In cases ofintracranial mas s lesion with dis - senen a ufgezeigt. Hierbei verd ient Beachtung, daß diese
placem ent of th e midline str uctures end increas ing [e p, Zysten, die etw a die Hä lfte aller intrak ra niellen Arac h-

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osteoplastic craniotomy ts performed and the medial noidalzysten ausmachen, durch lan gsame Größenzu-
wa ll of tbe cyst is resected down to the tentorial notch . nahme Ursa che lokaler Hirndruckzeichen und von Li-
with opening tnto the basal ciste rns . Ther e were 00 quorzt rkulationsstörungen sein könn en. Besonders bei
operative or postoperative complicat ions in 18 consecu- Kind ern besteht die Gefahr subduraler Blutungskompli-
tive cas es. However, one boy required a cysto peritoneal kationen nach leichten Schädelhirn verletz ungen und die
shunt 3 months la ter as a result of hydrocephalus fol- Möglichkeit von zerebralen Kr ampfanfällen. Schließ lich
lowing subdural hematoma a nd two other pati ents were bewirken die Zyste n eine Entwicklungshemmung der
also subsequently shunted. Asymptomatic a raeh noid verlagert en und komprimiert en Hirnlap penstru ktu ren.
cysts are disoussed with the respect to brain function die sieh nach erfolgreicher Entlastun g wieder a usdeh-
and potential risks. nen. Die Vorteile der mikrochirurgischen Zyst enwand-
resektion mit Wiederherstellung einer freien basale n
Key-words Uquorzirkulation sowie die Möglichkeite n eines ven-
triku lo- oder zysto-peritoneale n Shunts wer den auf-
Arac hnoid cyst s - Subdura l hematoma - grund eigener Erfahrungen und unte r Berücksi chtigung
Hydr ocephalus - Peritoneal shunt - Microsurgica l tech - der Literatur diskuti er t.
nique - Congemtal Jestons

Introdu cnon 60 % to 90 % of pe uents in mixed sories have been shown

to be in the pediatric age group (I , 2, 8, 9, 14- 17). The dis -
Although recent studies ha ve evaluated new tribution of arachnoid cysts in two hundred and eight col-
concepts of the pathogenesis. anatomieal ultrastructure, lected cases of Rengachary et al. (17) was as follows . Syl-
clinioal an d radiclogical manifestations of intr aarachnoid vian fissure, 49 %; cerebellopo ntine angle, 11 %; supra-col-
cysts, as the y are called today, the re ts an ongotng debate licula r a rea , 10 %; the vermts. 9 %; sella r and suprasellar
a s to the cho iee of their proper surgi cal treatment in re - area. 9 %; interhemispheric fissure , 5 %; cerebral convex-
spect to the final outcome of patients in the pedtatric and ity, 4 %; the d ival and interpeduncular a rea. 3 % . This
ad ult age group (5, 8, 10, 12,1 5, 16. 21, 23). Since the ad - paper will deal exclusively with cysts ofthe mlddle cranial
vent of cranial com puterized tomography (CT). num erou s fossa since they consütute abo ut one ha lf of all cases and
case reports have been presented. We are in a greement a re of major neurosur gtcal interest on account of malfor-
with most of the se a uthors that these lesion s are much matio n of the base of the skull and fronto-tempora l bone,
more common the n previously rea lized when they are dt- progressive hydrocephalus syndrome , epilepsy, and are an
agnosed by chance being asym pto mati c before. According im porta nt cause of associated hemorrhagic comp lications
to Robinson (19, 20) arachnoid cysts account for ahout 1 % after minor head trauma (1, 4, 5 - 9, 11-13, 17, 18,27).
of all atra umatic intracranial mass lestons. Most of the
cysts become symptomatic in ea rly ch ildhood in so far as Pathology

Morpho logical studies during the last two

decades have elucidated the pa thogenesis as weil as the
Neurochirurgia 35 (1992) t 77- 182 anato mieal ultra structure of intraarachno id cysts , which
© Georg Thleme Verla g. Stuugart - Npw York were described for the first tim e by Bright (3) in 183 1.
178 Neurochirurgia 35 (1992) K. VOll Wild

llowever, the cause of the a rachnoid eysts in generar re- 61. 'IoRengachary and Watanabe (17, 18) the eredit is prin-
mains still controverstal. They are classlfled today Into two cipally du e that they were a ble to demonstrate wit h light
groups: and eleetron mtcroscopic Iindings the splitting ofthe araeh-
- first: ccngenita l ma lform ations tptgs. 1- 8) (4.8. 11, 17 - nold membrane to enclose the cyst, wh ile the pia ma ter re-
20 .2 2,25) . ma ins as aseparate Inta ct membra ne (Fig. 7). Moreover
- second . resulting from lnfla mmatlon , herncrrhage. tra u- the cyst wa ll was rein forced with a den se collage nous layer
ma , tumor (1 . 12, 24). in respo nse to high intraeystie prcssure. whic h may be suf-
fieient 10 ca use erosion a nd expa nsion of the ealvarium.
Distin ct from these intra ar a chnoid eysts the Th us. intr aarachnoid cysts are a develo pme ntal a noma ly of
middle -fossa pitholes and the tnt radiploic a raehnoid cysts the subarachnoid ciste rns in the developing embryo caus-
are different pa thogenetic enuues (26) . arid are not dis- ing a minor aberratio n in the CSF flow with in the suba-
cussed he re . The historieal rovlew shows tha t ara chnold rac hnoid space , and resulting in an increasing divertic u-
cysts ha ve been given a vartety of designa tions, reflecting lum wit hin the araehnoid me mbrane. This is why these
differe nt pathogenetie fac tors, for insta nce: ehronie cystic cysts oceur nearly always in relation to an su baraehnoid
arachnoiditis. meningitis serosa ctrc umsc rtpta. eh re nie ctstern . approximately half of them Involvi ng the Sylvian
a rac hnciditis. cere bral pseudotumur, leptomemngaal cyst, fissure (Figs. 1,4.6.7). Like lnte rhernispherlc cysts the Syl-
or simply pnmary oth erwise idio pathic arachno id cyst (24). via n fissu re arachnoid eysts ten d to become very large
(Figs. 5. 6 ). The inte rmittently communieating type of cyst
There is clear cvlden ce that som e arachnoid (Figs. 2. 3) may expand by progressive accumulation ofCS F
cysts do commun icate with the suba raehnoid space. This is secreted through cells of the cyst wall rather than by osmo-
bea utifully demonstrated by isotope cistern ogra phy end tically induced filtratio n or uni -direetional CSF Ilow - the
still better today wit h cont rast me dium CT ctsternog ra ph y latter was called "ball-valve tr a pping " by Smuh an d Smith
(9) (Figs. 2 - 4). Aeeor din g to these functional studie s we call (1976) . This mechanismus has to be ta ken into aecount

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the m communicating or noncommunieating arachnoid wh en shunti ng procedere and resection of the cyst wa Uare
cysts. These cysts have to be dist ingu ished from morpho- discussed.
logica l findings like arachnotd diverüculum, ara chnoid
hernia, aru chnold pouch . internalmeningoeele, and arach- The contained fluid is usua lly clear and eo-
noidoceie (18). lorless. If the protei n content is higher than CSF. this ma y
be the residue of an intracystic bemor rhage. The latter h as
Starkman et al. (24) have demonstrated for bee n reported by us and others even a fte r min or head tra u-
the first tim e, by evalua ting histologica l deta ils. dtfferences ma , when acute or ehronie su bdural hemorrhage oecur in
in the a natomieal relationships of the idiopathic eysts from combination with intraarachnoid eysts mostly of the Syl-
those following inflamma tory or irritative eon ditions . vtan region (1, 5, 27).
Therefore th ey sug gested that these pr imary eysts originate
from anomalous developmental splitt ing of the araehn oid As already menuoned arachnoi d eyst of th e
me mbrane as they are enveloped by the leptom eni nges and middle fossa themselves re present compressive elements
related to the ctste rns and the subarae hnoid spaee (Figs. 3. ca using both loeal bulging and thinning of the temporal

Fig. 1 Cl scans 01 bilateral intraarachnoid

cvsts 01 the middle cranarrossa {l a, b1 in a 24
years oId man (HD 051 1641who was admitted
because 01 beadaches arid ecaectc fits with
tocar spike eno wave electrical octivity over the
left !rontotemporal region. EpidurallCP measure-
ment was in normal renge. Microsurgical ooeo
ing 01 theleft cyst with cecorcresscn Uarge
black errowl 01 the temporal lobe tsmeu black
arrow, I cd). Chronic subdural hematoma fron-
tal light due to oeccrcresson 6 weeks post-
operalively (l d).

Fig. 2 Cl scans alter lumbar injection 01 suae-

rochnoid contrast medium lor cislemography to
ovest aete CSf and cyst flu id communicalions
in a 29 ys old man (HGl 200656) with healf.
ache. Bulging and thinning 01 the right lemporal
bOlle over the exparidl1garachnoid cyst 01 the
middle lossa. Changes in mean density values
(ME) 01 the cyst Iluid demonstrate patent but
delayed communication 01 the cyst, although
signs and symptoms of Iocal compression were
present: a)and b) ME alter 12 hs 13.7 HE arid
10.2 HE; c} alter 24 hs 17.8 HE; d)alter 72 hs
Ara chnoid cys ts of the middle cranialfossa {I,!elUochirurgia 35 (1992) 179

bone (Fig. 21. eleveno n of the lesse r a nd a forward projec-

tion of the gr eater sphenoid wing. so that the middle rosse
on the side of the cyst becom es wider than that on the nor -
ma l side (91. For eshortening er the tempora l lobe. as the
cyst occupies the a nterior or the posterior temporal area, ts
demonstrated by er and magneue resonace imaging (MRI)
(Fig. 21. 111e tip of the temporal lobe may be abse nt al-
though the gyrt on the adja cent part of the bra in are ncr-
mal while th e insula is exposed and its opercu la absent in
the sense of a dysgeneti c temporal lobe (Figs. 5.61. 111e cysr
may be small or terge . mostly rectan gular in horizontal Cr-
cuts. a nd sometimes on bcth sides (Figs. 1,21. Displa ce-
ment of the frontal lobe (9) may be also present (H gs. 2, 6).
Reexpansion of the brain can be observed after success ful
opera tive treatme nt with decompression (Fig. 8). It is likely Fig. 3 Cl scens demonstrating a noocomnuücating iltraarachnoid
tha t the case in whlc h the cyst disappeared sup ports the cyst 01 the left middle crarsa tcssa 1 h after contrasl medium cisterro-
theory of abnorma l development af the subar achnoid space graphy fl a 54 yeers old female !WB 190238) admrtled beceuse of hee-
as opposed to the cyst remaini ng as a conse quence of ab - daches.
normal development of the temporal lohe during fetal life
(Fig. 81. ücclustcn of the tento rial stn ue. tnto which the
telencephaltc vein flows , has been descr ibed when the Syl-
vian vein is not visualize d on cerebral angiography (8. 9);
the combina tion with an arue rto -ven ous rnallorm ation of

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the sa me regten may confirm thls thoory (Hg . 5).

Clinical aspects

Most of the intraaraehnotd cysts 300m 10re -

main asymptomatic throughout the life . How ever; the
physical a nd neurological signs a nd symptoms. if they oc-
eure. reflect their mass effect on compressed adjacent te m-
poral br a in structures an d on 3rd an d 6th erentel nerves Ag.4 Cl scens demonstrating a COOVTUlCamg Iltraaractnoid cyst
01tre left mIlkIe t rarwal fossa 2 h aftercontrast medUni cstero-
be sides their elTect on CSF flow causi ng hydrocephalus. In gra~ 13 e. bl with cooseaerce 01~Il:oneal s/'IlI'll: ooce-
our series, 18 patients with middle cranial rosse CYSIS (3 dlSe13 cl 111 a 35 years oIdman (K-HH 1102S4J aaritted teceee 01
childre n. 15 adults i came 10 medical atte ntion an d were reeeecres.
ope rared because of hea daches la sting for years without
accompa nying ne urological deficits in all but two. Follow
up er scans demonstrated increasing hydro cephalus that
caused intracranial hypertension an d vomiting only in two
adults. Convulsive seizures hav e bee n obs erved a s leading
symptoms in three cases. l\vo boys were admltted as
emergency ca ses suffertng from subdural hematoma after
mild hoa d tra uma . in whom the aracbnold cysts ha d been
asymp tomatic before (Fig. 8). vessels in the wall ofthe cyst
(Fig. 7) pa rticularly susceptible to trau ma may be respon-
sib le for the hem orrhage. as in patients (5.8.27).

er scans ma de the definitive diagn ose of

the mass lesion in aU our cases (2.9). MRI sca ns (Fig. 5) Fig.5 MRI scans CTR 2.10. TE 28. Ll8.0. SP 48.6 Dr. tneoe. MJn.
olTer superior diagnostic infor ma tion compared with er sterl tl traaanial evst cf the left rridde cranial fossa with speec h disturb-
scan s by d iscriminati ng bet\licc n the CSF of true arachnoid ances and diso/acement of ee lerl'l)Ol"a1 lobe as consequence of
cysts . residua l hemorrhage into or around the cyst. and the matlormation because 01 thecontinabon with a eleeO seated Ieft fron.
fluid of neoplastic cysts (6.81. Howe\'er in res pect to the tomedIobasai a-v-malfonnabonof Ihe i'lsula and caputn. caudattm 111 a
47 years 0Id mal pabeft [tti 08 03#40) oMlo was adrntted because of
bony structures we stiDprefer er as the diagnostic method epilepsy arid Ieftlroolotemporal headaches.
of choice an d include contrast medium cistemography for
the follow-up examinations (Figs . Z. 5. and 6).
Surgicalrreatmenl. rists. and outcome
Intraventri cula r and ep idural Ic r monitor-
ing did not correspond in our series with clinical signs and The two main questions a re the indications
symptoms of increased intra crania l pressure that was for sur~cal treatment an d the therapeutic elTect which can
ca used by CSF disturban ces or by the mass elTect itself. es - be expccled . Genera lly speaki ng. it depen ds on the com-
pecially in case of imp ressive hydroceph alic dilatation of plaints of the patient corresponding to objective c1inical
the ventricular system. findings. whether or not surgery is indicated after the diag·
nosis has been confirmed. Time an d type of appro priate
180 Neurochirurgia 35 (1992) K. von Wild

Fig. 6 MRI scans

20.03.90 lTR 0.52,
TE 20, SL 5, SP 5.5
01'. Thiede, Münster)
demonstrating a large
Ief! fronlotemporal
arachnoid cyst in a
23 veers old male
patent (SR 240267)
who was admitted be-
cause of headacne,
frontobasal psycho-
syndrome and
speech dislurbances.
Congential meucrrne
tion wilh dysplasia of
frontal and temporal
obes. lndication tor
cysto-pentoneal shunt Fig.7 Arac oooid cyst cf Ihe Ief! middle cranial fossa. Microsurgical
in resoect of CSF vew ot Ihesurtace with arachnoid membrane, reinforced wilh a cense
communicalion end collagenous layer and vesseis in Ihe wall crossing the cyst
expansion of lhe cyst.

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operative procedure have 10 be designed in the ind ividual
case of the pediatri c as we il as of the adult age group (1,4,
5,8, 10 - 12. 15, 16,2 1,23,25): Ta ppin g or shunting tho
Fig. 8 Follow-up Cl scan of a 7 yeers-old boyccerateo uoon for a
cyst. fenestrati on through a burr hole or tre ph ine operring. posl-traumatic subdural hydroma. al betete operaton (19 october
additional peri toneal shunting or exctston ofthe cyst (partly 1984), b)after ooeration (24 april 1986), demonslrating reorecemeot
or completely) arn reco mmende d. of Ihe rightlemporal lobe.

In dication for su rgical Intervention is ob-

viou s in cases of acute intracranial he morrhage an d evi- Contrary to this opinion from our experi-
dence of elevered ICP with hydrocephalus. In cases. how - ence we wish to suess that CT and microsurgica l tec h-
eve r; where the cyst seems asymptomatic, we have to take niques make cys t wall resccu on without shunting a safe
into account the significant risk of surgical treatment in th is surgical procedure. The practice in our d inic is as folIows :
vulnerable anato mical regten. even postoperative fatalJties
have becn re ported in prcvious papers (4, 20). This ts why In case of Sylvian cyst with intracra nial
so me authors sti ll emphasize conse rvative management in rnass effect. e. g. displacement of tem poral and frontal
patients with cysts drscovered fort ultously or those causing lobes and ofmidline structures. with CSF disturbances, os-
only mild cosmetic defects. We are in agree ment with teoplastic craniotomy is indicated as it is in case of compli-
Har sh et al. (8) who stressed the potential for hindcring the cated middle cranlal fossa cyst with su bd ural hygroma or
de velopment and function of adjacent brain. particu larly in hematoma. The cyst ts exposed th rough a free frontote m-
chü drc n. and for cyst ruptu re with int racystic he morrhage, poral bone flap (Hg. 7). After tap ping of the cys t 10 gai n ad -
or s ubdural hemo rrhage leading to sudden severe neuro- ditional expcsure. the anterior and medial pa rt of th e wall
logical deterioration . This has happened in two boys of our is resected atong its attachment to the normal arachn oid
sertes. Therefore Jfar sh et al. (8) recommended cyst-perito- and pia meter; down to the tentorial no tch, where the
nea l shunting procedures in all arachnoid cysts th at exert thickened wall of the intraarachnoid cyst and adjacent
a m ass effect. as weil as cyst-ventriculo pe ritoneal sh unting arachnoid membranes are cut. w üh opening of the supra-
in all cases if there ts an associated ventriculomegaly. setlar and prepontine cisterns tF ig. 7 ). Cranial nerves are
Arachnoid cysts ofthe middle cranial f ossa Neurochirurgia 35 ( 1992) 11'11

deccmpressed and vase ular structures within the waUa nd agree wlth Ha rsh et al. (1986), who proposed opera tive
sometimes erossing the cyst are preserved. The waU at - tre atment in all araehnoid cysts that exert a mass effuct,
tached to the dura of the middle eranial fossa and to the partieularly those in children. oven if they are clinically
tempora l lobe are not detaehed to avoid subaraehnoid asymptomatlc. We did not observe a ny eorre lation between
bleeding after the compressed brain strucrures have been size and sha pe ofthe eyst and increased ICP. The lanor was
released from the eyst waU and membranes. Watertight shown to be in a normal range preoperat ively in all cases
closure of the dura follows, without drainage or associat ed although the cyst was demonsu-ated to be "ball-valve tra p-
cyst- or ventric ulc-peritcneal shuntlng. and replaeeme nt of ping " and patients eomplained of headac he. In centrast to
the bone Ilap. cu rselves. some a uthors still prefer cystopcritoneal shunt-
ing as the first a nd the prooedure of chotce. Shunttng pro -
There wer e no operative or severe pos- cedure ean be the first step in the management of middle
toperative eomplications in our 18 consecuuve cases using cranial fossa cysts. beeause thts method is simple. safe. a nd
this teehnique. However 6 weeks alter decompression of a effective . However. these patients will rcmain shunt-du-
left temporal araeh noid eyst one male patient was read- pendent, as we have seen in scme patien ns operated upon
mitted beca use of a ehronic subdural hema tom at the eon- elsewhere. We ther efore recommend exposure of the cyst
tralateral side where there was another temporal arae h- by means of frontotemporal era niotomy, as in expanding
noid cyst. Beeause of the development of hydrocephalus mass lesions. So far as we know, larger series ha ve not
three patients needed a shu nting proeedure during the fol- been report ed that have dealt with the final outcome after
low up: one a eystoperiton eal 3 months after the evacu- operative management für asymptomat ic arachnoid eysts.
ation of traumatte subdura l hem atoma and partial resec- in respect of brain runenon and secta t beha vior. This will be
tion of the araehnoid eyst and two other patients required our tas k in the future.
ventriculoperitoneal drainage. The shunü ng proeedures

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resulte d in the immediate improveme nt of foeal neurologt- Referen"cO
c~s _
eal defieits and reexpansion ofthe temporal lobe as demon-
strated by CT postoperatively. We saw one translent 3rd I All el; L. M., 8. Galthof er; G. Ludurnes; W /J. S agE'1; /.: /I "PP'II'I;
nerve palsy lasting 3 weeks in ease of a very large eyst. H. Lectmer. Diagnosüc a nd tr eat rncnt uf mld dte fossa a ra chn oid
Tempora l seizures disappeared in th ree patients, although cysts and subdural hematorna s. J. Neur osurg . :H 119S1) :~()6 ­
the re were still foeal dysrhythm ie abno rma ltnes showing 3fJ'J
2 Anderson. FM. , 11. D. Seg all, W J.. Caloll: USr' uf computortzod
loealized slow waves or a n asymmetrie depression of the tom ography scannmg in su pr a u-ntcna! a rarh no id cysts. A Tl"
electr fcal aetivity but no further spikes and waves in the port on 20 child ren a nd four adults . J. rcourosur g. 50 (1979) 3J3
EEG. - JJ8
3 Brigh l. R.: rusoases ofthe brai n a nd nervous System. part I. m-
In aseries of 36 eases of supratentorial ports of rnedical cases: Selected wit h a vicw of Hlustrating the
cysts in children Cnoux et al. (4) reported epileptie fits in 18 sympt oms a nd eur e of dtseases by a re ferem'e (u mo rbid a nal -
eases as weil as mental and motor retardation in 19 child- om y, VuL 2. Lnndcn : Lengma n. Il I'E~S, Orm o, Ilrown. Orer-n,
ren when seteur es have persisted in spite of surgery in Patem oster-How, and Iligh ley. (183 1J. pp. 437-4 39
a bout 50 %! Moreover, one of these 16 ehildren developed 4 ChoIJ.X. M., C. Raybau d. N. Pillsard. J . nassoun. fJ. Gamba r(,/Ii:
lntracra ma l s u pra tentortal C)'Sl~ in r h üdre n excluding tumor
new gran d mal selzures with worsening of her neurologieal a nd parasitic cysts. Chtld's Ilrai n 4 (JeJ78) 15 - :-1 2
deficit even after ventrtculo-perttoneal shunt. 5 Geissingel; J. D., W. C. Kohlel; /1. IV Roöiuson. /.: M. /J(lI'is:
Arachno id cysts of the middle crania l fossa: surg ical ro nsidp r-
Although final outeome for epilepsy re- ati ons. Surg. Neurol. 10 (1978) 27 - J 3
mains, from these and other reports. still open we do be· {,Go. K. G., P. l'an Dijk. A. J.. Vitell et al.: ln tl1 rp n'ta tinn nf nuclE~ar
lieve that in patients, especially in children, open microsur - magnetic resona nce tomog ra ms of the brai n . J . Neurus urg . 59
l{ical reseetion ofthe medial wall ofthe araehnoid eyst is in- (1983) 574 -584
dieated in eases of focal epileptie pattern in the EEG rec- 7 Go. K. G.. 11. J. /lOllfhojJ. E 11. lJIa alllL: I~ IIm· illgrr. J. lIa rl·
ords related to the frontotemporal cortex, even if there is slJ.iker: Arachnoid cystes of thc sylviall fissurc. Evidcl\{'. ' nf nuid
secretio n. J. Neurusurg . W . (19S41 SOJ- SI::!
no inereased intraera nial pressure. CSF-disturbanees, and ~ lIarsh N . G. H., M. S. IJ. Hdward.~. C. ß. Wilso fl: [Iltrarranial
no loeal brain eompression or displacement. a rac:hnoid c:ysts in ch i ldr.~n . J . Neurosu rg. fi·t (l 9Sfil S3:' -S-I2
9 l1ay as hi. T.. S. An egau 'a. E Ilallda. S. K/lffl molO. K. Mori. T.
Conclu sion MUfflla . S MirU/a. 11. lIan da: Cliniral an alysis ur a mc h nnid
cysts in the m iddle fossa. Neu roch irurgia 22, (J E) 79) 201 -2 10
Comparing our res ults with those in the lit- 10 Kaplan. ß. J.. J. P. Mi rk ll!'. R. ParkJwrsl: Cysw]Jl1 riton l'al shun t·
erature , partial mierosurgieal exeision of the arae hnoid ing for ca nge ntial aradm uid c:ys(s. Child's brain 11 (l 9S-I1 3U4 -
cyst wall and opening of the basal cisters at the tentorial 311
nooch has proved to be an efTective and safe procedure. Re- 11 KalO. M., Y. Naka da, N. Ariga, Y. KokIIbo. 11. Mak illo: I'rng nosis
of four case s of pr imary mid dle fossa ara chn oid cysts in child-
expans ion ofthe compressed temporal lobe has been dem- ren. Child's Brain 7 (1980j I9:' -204
onstrated by CT. Can surgieal eure, however. be aehieved? l Z Marinov. M , S. Vndjiall. P. Itelzka : An {'valua tion of tlw s urgi ·
Loeal neurological deficits usually improve immediately ('.al tre a tm ent of intracra nia l a rac hno id cys(s in r hildrcn. Child's
after the operation. Headaehe and seizures may be dim- Nerv Syst. 5 (1989) 177 - 183
inished and can disappear, but the y may persist or increase IJ MaYI; V.• f: Aich ne r, G. lJalll'l; I. Mah.~I'llipoUI; A. l' al/lm :
in frequeney after deeompression . We therefore ean not Su pra tentoli al eXlra cere braJ eysts uf the midd ll' c:ra nia l fossa .
predict the outeome in arachnoid cyst<;, which have been Neuroc hirurgia 25 (1982) 51- 56
show n to be eongential, eompressing the brain and hinde- 14 Merlezes. A. II., ~t: EfJell. G. E Perr f'l : Arach noid "Ysl~ iu dl ild-
r ing the development and funetion of adjacent brain . We ren . Arch . Neurol. 37 (l 'Jl'HlI 168 -1 72
182 Neurochirurgia 35 (1 992) K. von Wild

15 Mi/hora/, T. 1/.: Pedlatric neurosurgery. Davis Philadelphia 2~ Starkman. S. P. . T. C. Brown. E A. unett: Cerebral araeh noid
(1978) cyste.J . Neuro pathol. Exp. Neurol. 17 (1958) 484 -500
16 Roimondt: A. 1.. T. Shi moji. F A. Guüerrez: Suprasellar Cysts: 25 VigouroUJ:, R. P. , M. cnoa . C. Banrtmd: Les kystes araehn oi-
surgical trea tment an d results. Chtld's Brain 7 (1980) 57 -72 diens conger uta ux. Neurochirurgia 9 (1966) 169 -187
17 Renga chary. S . S .. I. Hblanebe, C. Ti. Bracke ü : Pathogenesis of 26 Wei nand, M. E.. S. S. Rengacha ry. D. H. McGr egor. I. Watan abe:
intr acr anial araehnoid cyst . Surg. Neu rol. 9 (1978) 139 -144 lntr adtplnic arachnoid eysts. J, Neurosurg 70 (1989) 954 -958
18 Rengachary. S. S. , 1. Walanabe: Ultrastructure and pathogenesis 27 Wild , K. von. F. GI/llolla: Araehnoid cyst of the middle erentat
of intraera nial ara ehnoid cysts . J. Neuropathol. Exp. Neurol. 40 fossa - aplasia of tempo ral lobe? Child's Nerv Syst 3 (1987) 232
(981) 61 -83 - 234
19 Robinson, R. G.: Th e temp oral lobe agc ncs ts synd rome. Brain 87
(196 4) 87 - 106
eo Robi nson. R. G.: Congeni tal eysts of the brain: a raeh noid malfor-
matten. Prog. Neurol. Surg. 4 (971) 133 - 174
21 SOlO. K., T. Shimoji. K. Yagl/shi. If. Sum te. Y. Kuru. S. {shiL,
Middle rosse
arachnoid eysts : chnical, neurnradiolngical an d K, von Wild
surgical features. Child's Brain 10 (1983) 301 - 3 16 Neuroeh ir. Abt. Clemenshospital
22 Show. c.: Araeh noid cysts of the Sylv tan fissur e ver sus temp oral Akade misches Lehrkran kenhaus
lobe agen esis synd rome . Ann. Neurol. 5 (1979) 483 -485 der Westf. Wilhelms-Uni v.
23 Smith, R. A.. W. A. Smith: Araehnoid cysts of the middle erente l Düesbergweg 124
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