Symptomatic arachnoid cysts in adults: illustrative cases

BACKGROUND Although intracranial arachnoid cysts are often asymptomatic, a small subset of patients develop debilitating symptoms. A cohort of patients with arachnoid cysts with varying presentations underwent endoscopic cystoventriculostomy, with a significant reduction in symptoms. OBSERVATIONS Three patients presented with chronic complaints, all involving headache in addition to other symptoms, and were noted to have large intracranial arachnoid cysts on imaging. Following endoscopic cystoventriculostomy, symptom reduction was both rapid and significant. Postoperative imaging revealed slight changes in cyst size and improvement in mass effect. LESSONS Endoscopic cystoventriculostomy for symptomatic arachnoid cysts in adults can decrease the chronic symptoms related to mass effect. Careful planning of the surgical trajectory to target the portion of the arachnoid cyst nearest to the ventricular wall allows for a safe and effective intervention that can lead to significant improvement in symptoms.