C.

Þokluk
Ëenel1
A. S
Spontaneous Disappearance of Two Asymptomatic F. Þelik1
Arachnoid Cysts in Two Different Locations H. Ergür2
Original Article

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Abstract Introduction

We report two children with asymptomatic arachnoid cysts
which resolved spontaneously without any surgical intervention
and history of major head and body trauma. The first child was a
10-year-old boy with an arachnoid cyst in the right sylvian fis-
sure. The second child was a 1-year-old girl with a right cerebral
convexity arachnoid cyst. Both of them were asymptomatic.
Arachnoid cysts spontaneously disappeared within 2 years
following initial diagnosing. There was no major head and body
trauma except usual home, school and sports activity. We specu-
lated that the cysts ruptured into cerebrospinal fluid circulation
by the mechanical effects of some forced activities to the brain
tissue and cyst, such as excessive breathing, coughing and sport
110 activities. These factors may change the balance between intra-
cystic and pericystic pressure and facilitate the rupturing of the
cyst into subdural, subarachnoid and intraventricular spaces.
These cases demonstrate that neurosurgical intervention of
asymptomatic arachnoid cysts is not absolutely indicated in the
paediatric age group. Close follow up with computerized tomo-
graphy (CT) and magnetic resonance imaging (MRI) is a treat-
ment option in the patient with arachnoid cysts located in the
middle cranial fossa and cerebral convexity.
Arachnoid cysts can be described as benign developmental cysts
that arise during development from splitting of the arachnoid
membrane [1]. Cystic cavities can develop at any site in the sub-
arachnoid space and cisterns along cerebrospinal axis [1, 2]. They
are relatively common space occupying lesions encountered in
neurosurgical practice [1 ± 3].
The introduction of CT and MRI has facilitated the diagnosis of
arachnoid cysts in both of symptomatic and asymptomatic pa-
tients [2, 4].
Arachnoid cyst has different natural history in the individual pa-
tients. Some of these cysts can be asymptomatic throughout life.
Some of them can remain asymptomatic for many years before
showing some clinical symptoms. A very small number of them
may disappear spontaneously [2, 3, 5 ± 10].
In this report, we present two cases with arachnoid cyst which
spontaneously disappeared during the two years period follow-
ing initial diagnosis. We discuss the possible mechanisms of
spontaneous disappearance of the arachnoid cysts.

Key words
Arachnoid cysts ´ asymptomatic arachnoid cysts ´ cerebral con- Case Reports
vexity ´ spontaneous disappearance
Case 1
A 10-year-old boy was referred to our neurosurgery department,
with a history of a mild unspecific headache. In neurological
examination, we did not detect any abnormal findings. MRI
showed an arachnoid cyst in the right sylvian fissure (Fig. 1a).

Affiliation
1
Ondokuzmayõs University, Medical Faculty, Department of Neurosurgery, Samsun, Turkey
2
Academia Magnetic Resonance Centre, Samsun, Turkey

Correspondence
C. Þokluk, M. D. ´ Department of Neurosurgery ´ Ondokuzmayõs University ´ Medical Faculty ´ 55139 Samsun ´
Turkey ´ Phone: +90-362-457-60 00/2625 int. ´ Fax: +90-362-457-60 41 ´ E-mail: cengizcokluk@yahoo.com

Bibliography
Minim Invas Neurosurg 2003; 46: 110±112  Georg Thieme Verlag Stuttgart ´ New York ´ ISSN 0946-7211

Fig. 1 Imaging studies of case 1. a Axial T2-weighted MRI scan shows
right sylvian arachnoid cyst. b Follow-up axial T2-weighted MRI after 18
months when the patient was 12 years old shows nearly complete re-
solution of the arachnoid cyst without intervention or treatment.
His clinical and neurological condition remained stable. Follow-
up MRI was performed 18 months after the first examination.
Follow-up axial T2-weighted MRI at 18 months when the patient
was 12 years old shows nearly complete resolution of the arach-
noid cyst without intervention or treatment (Fig. 1b). The patient
and parents did not note any history of trauma along this time
period.
Case 2
This 1-year-old girl baby was referred to our neurosurgery clinic
from the paediatric department because of microcephalic head
circumference. CT showed a large right cerebral convexity arach-
noid cyst (Fig. 2a). We firstly planned MRI examination and later
cystoperitoneal shunt placement. The parents of the patient did
not accept any further neuroradiological investigation and neu-
rosurgical intervention.
17 months later following the first examination, the child's father
brought the baby for examination. CT showed spontaneous dis-
appearance of the arachnoid cyst without any neurosurgical in-
tervention (Fig. 2b). The parents did not report any history of ma-
jor head and body trauma.
Discussion
The incidence of arachnoid cysts accounts for approximately
1 percent of intracranial space occupying lesions [2, 5]. Supraten-
torial arachnoid cysts are most commonly located within the syl-
vian fissure [11]. Nearly half of them occur in this location [2, 6].
Þokluk C et al. Spontaneous Disappearance ¼ Minim Invas Neurosurg 2003; 46: 110 ± 112
Original Article
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Fig. 2 Imaging studies of case 2. a Axial CT scan shows right cerebral
convexity arachnoid cyst. b Follow-up axial CT scan after 17 months
when the patient was 3 years old shows complete resolution of the
arachnoid cyst without intervention or treatment.
The cerebral convexity is one of the least common sites. The fre-
quency is about 4 % of all intracranial arachnoid cysts [1, 2].
111
The histological structure of the wall resembles that of normal
arachnoid membrane that is mainly formed by laminated colla-
gen bundles [2]. The histopathological studies demonstrated the
splitting of the arachnoid membrane at the margins of the cyst
[2]. The wall of the cystic cavity is formed by both inner and out-
er layers of arachnoid. These layers consist the islands and/or
clusters of mesothelial cells in the wall [2,11]. The role and the
importance of mesothelial cells, tensile strength and elasticity
of the membrane remain as unanswered questions. The brain tis-
sue underlying cysts is generally normal but in rare instances
some degree of gliosis may be present [2,11].
Arachnoid cysts may rupture into the subdural space, basal sub-
arachnoidal cisterns and ventricles [6,12]. Increasing intracystic
and percystic pressure by factors such as breath holding, forced
breath, coughing, crying, swimming and sport activities may be
facilitating factors in the rupturing of the cysts.
Some previously reported articles addressed spontaneous disap-
pearance of arachnoid cysts located in the middle cranial fossa
[3, 4, 6 ± 10]. We could not find any article that reports spontane-
ous disappearance of arachnoid cysts located in the cranial con-
vexity. Arachnoid cysts located in the cerebral convexity are rare
[1]. This group of cysts is far from the basal subarachnoidal cis-
terns. In our second case, the cyst may have ruptured into the la-
teral ventricle.
 The diagnosing age of the cysts is different in our cases. One of
them was 10 years old (the first case). This is the primary school
age. In these days, the students learn some sportive and gymnas-
tic activity including football, basketball, running with forced
breathing and efforts. The second of our cases was 1 year old. In
these years children learn steps and walking with sometimes fall
down on the ground. Both of these patients may have been ex-
posed to some different type of minor skull and body traumas.
We speculated that cystic cavity may be affected by minor trau-
mas in two different mechanisms. One of them is the rupturing
theory. According to this theory, the cystic wall is ruptured by
the effects of minor traumas associated with increased pressure
in the brain tissue around the pericystic area. The second mecha-
Original Article
nism is the inverting of the ball valve mechanism from the cyst to
adjacent cisterns or ventricle.
Conclusion
Arachnoid cysts are dynamic lesions which can be affected by
the factors increasing or decreasing intracystic and intraparen-
chymal pressure. Rupturing into subdural, subarachnoid and
ventricles, decreasing and disappearing can be seen in the natu-
ral behaviour of this type of lesions. In asymptomatic paediatric
cases, observation with serial CT and/or MRI imaging and neuro-
logical examination should be essential prior to deciding on neu-
rosurgical intervention. We suggest that close follow-up should
be considered as a treatment modality for the patient with
asymptomatic arachnoid cysts.
112
Þokluk C et al. Spontaneous Disappearance ¼ Minim Invas Neurosurg 2003; 46: 110 ± 112
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