Primary arachnoid cyst - an early postoperative complication after microsurgical resection

Arachnoid cysts (AC) are benign, non-neoplastic fluid-filled malformations of the arachnoid tissue. Approximately 50-65% occur in the middle cranial fossa and predominantly on the left side, followed by retrocerebellar and convexity locations. Tremendous development and usage of cross-sectional imaging modalities suggest a higher prevalence of AC than previously thought. Since large arachnoid cysts express mass effect on surrounding neurovascular structures, a surgical approach is preferred to passive observation. Nevertheless, the symptomatology is frequently subjective and difficult to validate, and the causal link between symptoms and an arachnoid cyst is often dubious. Therefore, the operative indication and the best surgical modality for patients with AC remain controversial. Surgical options include opencraniotomy or endoscopic cyst fenestration, cystoperitoneal, cystosubdural, ventriculoperitoneal shunt insertion, or marsupialization via a craniotomy. The complications of these procedures include subdural hematomas, hygromas, hydrocephalus, cerebral edema, postoperative secondary arachnoid cyst, and, more rarely, remote intraparenchymal or subarachnoidal hemorrhage.