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Arachnoid cysts: a diffuse spinal fluid absorption abnormality?


Cerebrospinal fluid (CSF) homeostasis is quite complex, and does not always present in a diffuse form such as hydrocephalus. In some situations, a focal manifestation of this global circulation abnormality is identified, such as arachnoid cysts (most often in the temporal fossa). These patients with temporal arachnoid cysts develop shunt dependency, as spinal fluid circulation seems to be affected permanently.

Materials and methods

7 patients (ages 4–16 years) were initially treated with craniotomy (2 endoscopic) and cyst fenestration for temporal arachnoid cysts (measuring 4–8 cm. In size), but eventually required a shunt for drainage. Four of these children presented with subdural hemorrhage after rupture of the arachnoid cysts, presenting with signs of increasing intracranial pressure. Despite decreasing cyst size, all the patients developed a form of shunt dependency, requiring shunt revisions for malfunction. Ventricular enlargement was not seen during these episodes, and repeat attempts to fenestrate the cysts were not successful. Multiple shunt revisions (average 4.5) were often required before symptom resolution.


Some patients with diffuse cerebrospinal fluid circulation abnormalities present with focal cystic accumulation of CSF arachnoid cysts, and focal drainage or communication may not be adequate to relieve symptoms. A diffuse spinal fluid absorption abnormality (similar to pseudotumor cerebrii, or form fruste of hydrocephalus) may be focally expressed, suggesting another etiology or treatment option might be indicated.


Arachnoid cysts may represent a focal expression of an underlying global cerebrospinal fluid absorption problem.

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Correspondence to Jogi V Pattisapu.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Pattisapu, J.V., Olavarria, G. & Gegg, C.A. Arachnoid cysts: a diffuse spinal fluid absorption abnormality?. Fluids Barriers CNS 6 (Suppl 1), S30 (2009).

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