I'm a 28 yo femlae with fibromyalgia but otherwise but otherwise in good health except a history of migraines and headaches since age 2. I've been dealing with the same constant headache for the last five weeks with continually worsening symptoms. Vision loss, black spots, confusion, falling - it has all lead in the way of a diagnosis of pseudotumor cerebri. In the process of all this, a 7cm*2.5cm*3.5cm arachnoid cyst was discovered. In the ER of a large regional hospital, the ER doctors wanted to do a lumbar puncture to diagnos/treat the headache and obtain a CSF sample. The neurosurgery resident vetoed the LP saying that the postitioning and size of the cyst posed a serious risk if my intracranial pressure dropped because it could swell and compromise my vital functions. Am I wrong in wanting the neurosurgeon I am to consult with to fenestrate the cyst so it will not cause future problems? I understand that most surgeons don't want to operate on benign cysts but this one is preventing me from getting treatment. From the information I was given, Pseudotumor cerebri can recur. I would rather take care of the cyst so it is a non-issue and the LP can be completed. Any opinions?
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.
Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
Arachnoid cysts are sacs filled with cerebropsinal fluid (CSF) which is the fluid that normally bathes the brain and spine. This fluid is normally located in the part of the brain called the subarachnoid space.
Most commonly, these are primary arachnoid cysts, cysts that are present from birth and result from a minor developmental problem that occurred while the brain was developing. Secondary arachnoid cysts are those that develop secondary to trauma, infection, or after brain sugery. It is not always possible to tell if the cyst you have is primary or secondary.
If an arachnoid cyst is deemed to be causing symptoms or is pressing on surrounding structures (which would most often be evident on your MRI), surgical opening (fenestration) of the cyst and other surgical interventions could be done to correct it, but this is rarely necessary because the vast majority of arachnoid cysts are benign, do not grow, and do not cause symptoms. Sometimes, re-imaging to take another look at it after a few months or years may be indicated. It is a good idea for you to ask your physicians about more information about the cyst, what the implications of having it is, so you can have a good understanding of it; continued followup with your neurologist is recommended. It is not wrong to ask for a neurosurgery consult particularly if they feel it could be symptomatic.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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