Arachnoid cysts: does surgery improve epileptic seizures and headaches?

During the period from 1985 to 1992 we treated 43 patients with intracranial arachnoid cysts (ACs). In this retrospective study we assessed the outcome of these patients with regard to non-specific symptoms such as headaches and epileptic seizures. Twelve patients had headaches of obscure origin and a mostly temporal located AC. Six of these 12 underwent surgery. After the operation 4 patients (4/6) had no further headaches, two remained unchanged. The other 6 conservatively treated patients (6/12) had further headaches. Ten of the 43 patients had epileptic seizures. One patient dropped out of the survey. Six of the 9 remaining patients had a temporal AC. Four of these 6 underwent surgery; postoperatively the seizure disease of 3 patients (3/6) declined. One patient was unchanged. Two patients with epileptic seizures and a temporal AC did not undergo surgery and both improved. Three patients with seizures had a convex located AC. Two of these 3 underwent surgery. The first patient improved postoperatively, the second patient remained unchanged. There was a reduction in the seizures of the medically treated patient. It remains ambiguous, whether there is a relationship between epileptic seizures and intracranial ACs without obvious intracranial pressure signs. A review of the literature, however, showed mostly positive results concerning the surgical treatment of ACs under conditions of simultaneous epileptic seizures. However, the results largely depend upon the definition of the decline of the seizures with regard to the postoperative follow-up, therefore we must remain skeptical. Therapy guidelines in the future not only depend on the clarification of the pathophysiology of the ACs, but also on a resonable outcome examination.