Simultaneous bone remodeling and surgical decompression of large Sylvian arachnoid cyst

The most common location for intracranial arachnoid cysts is the region of the Sylvian fissure, where they can be found in 49% of cases. Management of these cysts is still quite controversial. We present our surgical technique for the treatment of large Sylvian fissure arachnoid cysts which involves cyst decompression and simultaneous calvarial remodeling. After decreasing cyst size, remodeling of the frontal, temporal, and parietal bones follows. The cyst itself is treated with a cystoperitoneal shunt. In immediate postoperative period, correction of the deformity is observed. The cyst volume is reduced immediately after surgery, and adequate adaptation of the bone is achieved. Our surgical procedure for simultaneous bone remodeling and cyst decompression is a fast, simple, and effective treatment option for patients with large Sylvian fissure arachnoid cysts associated with significant cranial disfigurement. We consider cranial remodeling in case of large arachnoid cyst important not just because of the cosmetic result but also for reducing remaining intracranial space filled with cerebrospinal fluid. It may be an important factor to reduce the risk of intracystic and subdural hemorrhage. It is a widely applicable procedure that does not require special tools and expensive equipment, and yet it can help avoid multiple surgeries and complications tied to them.