Intracranial arachnoid cysts with mass effect are detected frequently in asymptomatic patients. Conversely, symptomatic patients may present without imaging signs of a focal mass effect that emphasizes the difficulty of relying on imaging as the sole criteria in surgical selection.
Although it is generally accepted that asymptomatic or paucisymptomatic cysts do not require surgical treatment, there is no consensus on the therapeutic approach of choice in symptomatic cases 1).
Acetazolamide known to reduce CSF production, might mimic surgical decompression and therefore could serve as a decision-making tool in patients with ACs.
A total of 103 patients with radiographically proven ACs were initially identified. Twenty (19.4%) were symptomatic and underwent a trial of oral AZM. Data were collected meeting inclusion/exclusion criteria for this cohort study and analyzed retrospectively/prospectively. Results Overall, 17 patients were able to tolerate the AZM and had at least some subjective improvement in their symptoms during the AZM challenge and underwent surgical therapy. Surgery was beneficial in 16 patients (94.1%). Following surgery, symptoms resolved in 13 patients (76.5%) and improved in 3 (17.6%).
The AZM challenge may support the clinical decision to recommend surgery in those patients whose symptoms improve during AZM therapy 2).