Background: There are yet to simplify some aspects regarding the surgical indications and surgical procedures that are at choice for treating intracranial arachnoid cysts. The purpose of this retrospective analysis is to contribute to the continuing debate on the most suitable management. Materials and Methods: We included in the study 66 patients, operated for intracranial arachnoid cysts during the period January 2008 to December 2017. The surgical methods were either a craniotomy or cyst shunting. The information regarding these patients was retrospectively assessed based on their clinical and imaging records. Treatment efficiency was evaluated considering postoperative clinical status, imaging appearance and postoperative complications. Results: 84.1% of the patients reported postoperative disappearance or reduction of symptoms, while 13.6% had the same complaints as prior surgery. Only 2 patients experienced worsening of symptoms. Follow-up imaging showed cyst disappearance in 29.5% patients and cyst reduction in 61.4% patients. 9.1% had no change in cyst volume. Craniotomy correlated with a better imaging appearance (p=0.02). There was no correlation between improved clinical status and cyst fluidreduction (p=0.6). 14 patients (21.21%), all with temporal cysts, experienced postoperative complications, and 10 of them (15.1%) needed surgery. There was no severe or permanent dysfunction in any of the patients. 42.8% of the cyst shunting patients suffered postoperative complications, whereas only 10% of the craniotomy patients did. Conclusion: Cyst decompression results in significant clinical improvement and it can be performed with little risk for severe complications. Craniotomy seems to be a better surgical treatment option than cystoperitoneal shunt, with a better neuroimaging appearance and a lower complications rate.

Keywords: Arachnoid Cyst; Cysto-Peritoneal Shunt; Craniotomy; Marsupialization.