Treatment of Arachnoid Cyst with History of Weakness

Diagnostic Approach

Brain MRI and non-contrast CT scan are recommended for newly diagnosed cases to properly classify the cyst, according to the Clinical Infectious Diseases guidelines 3
MRI with 3D volumetric sequencing is strongly recommended for better visualization of cysts, especially those in the ventricles or subarachnoid spaces, as suggested by the Clinical Infectious Diseases guidelines 4, 1
For patients with hydrocephalus, MRI with 3D volumetric sequencing is particularly important to identify intraventricular and subarachnoid cysticerci, as recommended by the Clinical Infectious Diseases guidelines 1

For cysts in lateral and third ventricles, removal by minimally invasive neuroendoscopy is recommended over other surgical or medical approaches, according to the Clinical Infectious Diseases guidelines 1
When surgical removal is technically difficult, shunt surgery for hydrocephalus is suggested, as recommended by the Clinical Infectious Diseases guidelines 1
Corticosteroids should be administered in the perioperative period to decrease brain edema, as suggested by the Clinical Infectious Diseases guidelines 1

Patients with subarachnoid cysts should receive antiparasitic drugs, according to the Clinical Infectious Diseases guidelines 1
Anti-inflammatory therapy should be initiated prior to antiparasitic drugs, as recommended by the Clinical Infectious Diseases guidelines 1
For patients requiring prolonged courses of anti-inflammatory therapy, methotrexate may be considered as a steroid-sparing agent, as suggested by the Clinical Infectious Diseases guidelines 1
Patients with hydrocephalus from subarachnoid cysts should receive shunt surgery in addition to medical therapy, according to the Clinical Infectious Diseases guidelines 1

For patients with spinal cord dysfunction, corticosteroid treatment is recommended, as suggested by the Clinical Infectious Diseases guidelines 1
Both medical and surgical approaches should be considered, according to the Clinical Infectious Diseases guidelines 1
Management should be individualized based on symptoms, location of the cysts, degree of arachnoiditis, and surgical experience, as recommended by the Clinical Infectious Diseases guidelines 1

All patients should undergo fundoscopic examination prior to initiation of anthelminthic therapy, as recommended by the Clinical Infectious Diseases guidelines 3
For patients likely to require prolonged corticosteroids, screening for latent tuberculosis infection is suggested, according to the Clinical Infectious Diseases guidelines 3
Screening or empiric therapy for Strongyloides stercoralis is suggested for patients likely to require prolonged corticosteroids, as recommended by the Clinical Infectious Diseases guidelines 3

There is no evidence that management of arachnoid cysts in children should differ from adults with the same form of disease, though dosing should be weight-based, according to the Clinical Infectious Diseases guidelines 1