Untitled

Abstract

Background: Intracranial arachnoid cysts (AC) rarely enlarge and become symptomatic, especially in adults and when located retrocerebellar. This report describes an adult in which an expanding retrocerebellar arachnoid cyst prompted surgical resection and it provides an overview of the literature and recommendations for optimal management. Case presentation:A 65-year-old women was diagnosed with an incidental retrocerebellar AC. She presented 10 years later with headaches, aural fullness and poor balance. Consecutive MRI showed significant enlargement of the AC, associated with tri-ventricular hydrocephalus. She underwent cervico-cranial decompression, cyst fenestration and shunting. Her symptoms improved significantly. Post-operative MRI showed reduction in AC size and resolution of hydrocephalus. Conclusions:In adults, only a minority of ACs will enlarge and become symptomatic prompting surgical intervention. An optimal approach to management should focus on counseling around alarming symptoms rather than continual follow-up.