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Arachnoid Cysts

Arachnoid cysts are cerebrospinal fluid-filled sacs that are located between the brain or spinal cord and the arachnoid membrane, one of the three membranes that cover the brain and spinal cord. Primary arachnoid cysts are present at birth and are the result of developmental abnormalities in the brain and spinal cord that arise during the early weeks of gestation. Secondary arachnoid cysts are not as common as primary cysts and develop as a result of head injury, meningitis, or tumors, or as a complication of brain surgery.

The majority of arachnoid cysts form outside the temporal lobe of the brain in an area of the skull known as the middle crania fossa. Arachnoid cysts involving the spinal cord are rarer. The location and size of the cyst determine the symptoms and when those symptoms begin. Most individuals with arachnoid cysts develop symptoms before the age of 20, and especially during the first year of life, but some people with arachnoid cysts never have symptoms. Males are four times more likely to have arachnoid cysts than females.

Typical symptoms of an arachnoid cyst around the brain include headache, nausea and vomiting, seizures, hearing and visual disturbances, vertigo, and difficulties with balance and walking. Arachnoid cysts around the spinal cord compress the spinal cord or nerve roots and cause symptoms such as progressive back and leg pain and tingling or numbness in the legs or arms. Diagnosis usually involves a brain scan using diffusion-weighted MRI (magnetic resonance imaging) which helps distinguish fluid-filled arachnoid cysts from other types of cysts.

Arachnoid Cysts Symptoms

Most cysts that will become symptomatic do so in early childhood. Specific symptoms depend on the location of the cyst, but can include: -

  • headache
  • nausea/vomiting
  • lethargy
  • seizures
  • mass protrusion in the skull
  • focal neurological signs secondary to pressure of surrounding structures
  • developmental delay
  • hydrocephalus due to obstruction of normal cerebrospinal fluid (CSF) circulation
  • endocrine symptoms such as early onset of puberty
  • head bobbing
  • visual impairment

Arachnoid cysts that do not cause symptoms or impact surrounding areas do not require treatment, no matter where they are located or how large they are. Otherwise, surgery is recommended.

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What Is The Prognosis?

Untreated, arachnoid cysts may cause permanent severe neurological damage when progressive expansion of the cyst(s) or hemorrhage injures the brain or spinal cord. Symptoms usually resolve or improve with treatment.

Complications List For Arachnoid Cysts

The list of complications that have been mentioned in various sources for Arachnoid Cysts includes: -
  • Permanent severe neurological damage
  • Brain hemorrhage
  • Intracranial space-occupying lesion
  • Radiculopathy
  • Hydrocephalus

What's The Treatment For Arachnoid Cysts?

Arachnoid cysts that do not cause significant mass effect or symptoms, regardless of their size and location do not require treatment. If there is severe mass effect on surrounding structures or if there are symptoms then surgical treatment is recommended. Treatment for arachnoid cysts is symptomatic. When symptoms warrant, the surgical placement of a shunt may be required to decompress (remove pressure from) the cyst.

Untreated, arachnoid cysts may cause permanent severe neurological damage due to the progressive expansion of the cyst(s)or hemorrhage (bleeding). With treatment most individuals with arachnoid cysts do well.

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