• Batuk Diyora, Bhagyashri Bhende, Gagan Dhall, Aditya Patil, and Naren Nayak.
• Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India. Electronic address: bhagyashribhende@gmail.com.
• World Neurosurg. 2019 Feb 1; 122: 577-582.

BackgroundCraniovertebral junction arachnoid cysts are uncommon. Among those reported, ventrally located arachnoid cysts at the extremes of age have been even rarer. We report a successfully managed case of a ventrally placed arachnoid cyst in an 88-year-old man using an unconventional surgical approach.Case DescriptionAn 88-year-old man presented to us with complaints of tingling and numbness in both upper and lower limbs. He had a weak handgrip on both sides. Spinal magnetic resonance imaging (MRI) showed a non-contrast-enhancing cystic lesion over the anterior lip of the foreman magnum that had displaced the cervicomedullary junction posteriorly. The lesion was homogenously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI. The lesion was excised using a posterior approach. The cyst contents were drained, followed by complete wall excision. Complete improvement in clinical symptoms and an absence of neurological deficits were noted in the patient.ConclusionArachnoid cysts are congenital lesions and can present at the extremes of age. Ventrally placed small symptomatic arachnoid cysts can be managed successfully through the posterior approach, especially in the elderly population.Copyright © 2018 Elsevier Inc. All rights reserved.

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