Arachnoid cysts are often an incidental finding on imaging studies. Patients are usually either asymptomatic or minimally symptomatic, despite the often impressive size of the lesion. The most common associated clinical features are headache, focal cranial prominence or seizures. Treatment of arachnoid cysts must be based upon the clinical findings and is somewhat controversial. Some believe that even asymptomatic patients should be treated aggressively, with decompression to avoid potential future complications. The most effective surgical treatment seems to be excision of the outer cyst membrane and shunting to the peritoneal cavity. Others advocate a more conservative approach with asymptomatic or minimally symptomatic cysts, as in this case. Serial MRI is appropriate in these cases to rule out rapidly enlarging cysts, which may indicate more aggressive management.
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