Arachnoid cysts of the middle cranial fossa. Surgical management for headache.

To answer the question whether headache in association with a middle cranial fossa arachnoid cyst without other signs warrants surgery, an analysis of five cases is performed. Three of 5 patients became free of symptoms, compared with 15 of 19 (79%) patients that have been collected in the literature. Both failures were treated with a low pressure cysto-peritoneal shunt without fenestration. They complained of headache resembling postural headache after lumbar puncture. Surgical treatment in the form of a craniotomy with fenestration can be advised, but is major neurosurgery. Alternatively, the merit of a cysto-ventriculo-peritoneal shunt should be considered in this group of patients.