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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Fluid Filled Arachnoid Cyst On Temporal Lobe

Hello I have an arachnoid cyst on my temporal lobe about 4 cm long. I have fluid on the outside of the cyst now which wasn t there before. I recently just had a seizure on August 1st, but my main concern is, is it okay for that extra fluid to be around my cyst like that? It s leaking. And secondly, my family doctor thinks that it could rupture. What happens if it ruptures? Thank you.
Wed, 9 Aug 2017
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Neurologist, Surgical,  's  Response
Hi, thanks for asking from HCM.


I can understand your concern. I am a neurosurgeon. I almost see 4-5 patients of arachnoid cyst every month. First I will tell you what it is? and then I will tell you when should it be operated?

What is arachnoid cyst? It is a benign congenital malformation, present as fluid (CSF like) filled cyst. It does not communicate with other CSF spaces. It is mostly asymptomatic and detected incidentally on CT or MRI brain. It's most common site is temporal lobe.
Sometimes, it can cause seizures, progressive increase in size, internal bleeding, obstruction of CSF pathways. In such case, it might become symptomatic. If symptoms respond to medication, no need to do anything.

If no response, then surgery might be needed. Surgery is usually fenestration of cyst membrane and opening it into other CSF spaces. Doing this, makes cyst a part of CSF spaces. The fenestration can be done by open surgery or by endoscopy.

In your case, rupture of cyst does not carry significance. As it will rupture into CSF spaces and automatically fenestration will happen. So don't worry about it.
Leaking of arachnoid cyst does not cause problem. Because the fluid consistency is similar to CSF. There will no symptoms due to it.

In your case, occurrence of seizures is important. If EEG is showing arachnoid cyst as the locus of seizure activity and seizures are refractory, the cyst can be considered for surgery. Otherwise, no need to worry about it. Follow up MRI brain after 1 year for 3 years and then 3 years can be done.

Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
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Suggest Treatment For Fluid Filled Arachnoid Cyst On Temporal Lobe

Hi, thanks for asking from HCM. I can understand your concern. I am a neurosurgeon. I almost see 4-5 patients of arachnoid cyst every month. First I will tell you what it is? and then I will tell you when should it be operated? What is arachnoid cyst? It is a benign congenital malformation, present as fluid (CSF like) filled cyst. It does not communicate with other CSF spaces. It is mostly asymptomatic and detected incidentally on CT or MRI brain. It s most common site is temporal lobe. Sometimes, it can cause seizures, progressive increase in size, internal bleeding, obstruction of CSF pathways. In such case, it might become symptomatic. If symptoms respond to medication, no need to do anything. If no response, then surgery might be needed. Surgery is usually fenestration of cyst membrane and opening it into other CSF spaces. Doing this, makes cyst a part of CSF spaces. The fenestration can be done by open surgery or by endoscopy. In your case, rupture of cyst does not carry significance. As it will rupture into CSF spaces and automatically fenestration will happen. So don t worry about it. Leaking of arachnoid cyst does not cause problem. Because the fluid consistency is similar to CSF. There will no symptoms due to it. In your case, occurrence of seizures is important. If EEG is showing arachnoid cyst as the locus of seizure activity and seizures are refractory, the cyst can be considered for surgery. Otherwise, no need to worry about it. Follow up MRI brain after 1 year for 3 years and then 3 years can be done. Hope it will help you. If still in doubt, do let me know. Thanks. Take care.