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Neurology (Expert Forum)
Re: Arachnoid Cyst
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Re: Arachnoid Cyst
by CCF Neuro[P] MD RPS, Jan 01, 1995 12:00AM
Posted By CCF Neuro[P] MD, RPS on December 19, 1998 at 23:45:14:
In Reply to: Arachnoid Cyst posted by Trina on December 18, 1998 at 11:51:30:
I am a 29 y/o female diagnosed with a large sub-arachnoid cyst. The cyst is located by my brain stem causing compression of the cerebellum and shifting of the quadreg. plates, empty sellar syndrome, and effecting the aqueduct of Sylvus. I under went a craniotomy 4 years ago at the University of Miami for fenestration. 4 weeks after the surgery and a seemingly quick recovery, I had a hemorrage at the surgical site. I was back in the hospital for another three weeks undergoing a series of lumbar punctures that lasted 8 days (my opening pressure was 440-what does that mean?). Two years ago, after the return of symptoms, I found out that the cyst had returned and was larger than before.
My symptoms are: pressure headache upon waking that usually get better by mid day, equilibrium difficulties, visual disturbances...and over the past 3 months or so I have noticed difficulty with my speech, almost like I know what I want to say but it doesn't come out correctly and in normal conversation my words get mixed up, as well as a bit of depression- could that be related to the pressure? What effect does having high CSF pressure cause? My doctors have recemmended that I have another surgery to install a shunt, but after my last surgical experience I am leary and they have agreed that I could wait. Am I putting myself at risk of permanent damage by not having this surgery done soon? What are the risks of the pressure rising to the point of danger? What is the recovery like after placement of the shunt? I am a single mom of a 6 y/o boy, another reason to put off any surgery. I have tried to convince my family and myself that all of this is no big deal, but I am truly starting to wonder if its time to consider another surgery. Its getting to the point where it seems to be effecting my every day life. Help!
Thanks...Trina
Dear Trina:
Sorry to hear about all your problems. Usually, arachnoid cysts do not require surgery unless they are inducing symptoms. It sounds as if symptoms are occuring. The symptoms in part, are where the arachnoid cyst is located. In general, increased in ICP induces symptoms such as diplopia, increased tone in the lower extremities, ataxia, headache, nausea, and vomiting. I think it would be wise to follow the recommendation about a shunt. However, not having examining you and seeing the brain images, it is not possible to give to completely accurate advice. Howver, with an opening pressure of 440 mm I think your ICP is very high. And yes, it can cause damage that is irreversible. The opening pressure is a measurement of the pressure of the fluid that is compressing the brain because the skull does not give way to pressure due to it's stiffness of solid bone. So, as the pressure inside your skull builds up the fluid is pressed against your soft brain. As the pressure builds up, the only structure that
can give way is your brain. This is what causes symptoms, and together with the enlarging cyst, your brain is really being squeezed. Unless you want to undergo multiple LP's (and with the cyst, this wouldn't end the symptoms) I think you are likely stuck with the fact that you need a shunt. You might consider a second opinion, but it sounds like the result will be the same. Best of luck, let us know if we can be of further help.
Sincerely,
CCf Neuro[P] MD, RPS
In Reply to: Arachnoid Cyst posted by Trina on December 18, 1998 at 11:51:30:
I am a 29 y/o female diagnosed with a large sub-arachnoid cyst. The cyst is located by my brain stem causing compression of the cerebellum and shifting of the quadreg. plates, empty sellar syndrome, and effecting the aqueduct of Sylvus. I under went a craniotomy 4 years ago at the University of Miami for fenestration. 4 weeks after the surgery and a seemingly quick recovery, I had a hemorrage at the surgical site. I was back in the hospital for another three weeks undergoing a series of lumbar punctures that lasted 8 days (my opening pressure was 440-what does that mean?). Two years ago, after the return of symptoms, I found out that the cyst had returned and was larger than before.
My symptoms are: pressure headache upon waking that usually get better by mid day, equilibrium difficulties, visual disturbances...and over the past 3 months or so I have noticed difficulty with my speech, almost like I know what I want to say but it doesn't come out correctly and in normal conversation my words get mixed up, as well as a bit of depression- could that be related to the pressure? What effect does having high CSF pressure cause? My doctors have recemmended that I have another surgery to install a shunt, but after my last surgical experience I am leary and they have agreed that I could wait. Am I putting myself at risk of permanent damage by not having this surgery done soon? What are the risks of the pressure rising to the point of danger? What is the recovery like after placement of the shunt? I am a single mom of a 6 y/o boy, another reason to put off any surgery. I have tried to convince my family and myself that all of this is no big deal, but I am truly starting to wonder if its time to consider another surgery. Its getting to the point where it seems to be effecting my every day life. Help!
Thanks...Trina
Dear Trina:
Sorry to hear about all your problems. Usually, arachnoid cysts do not require surgery unless they are inducing symptoms. It sounds as if symptoms are occuring. The symptoms in part, are where the arachnoid cyst is located. In general, increased in ICP induces symptoms such as diplopia, increased tone in the lower extremities, ataxia, headache, nausea, and vomiting. I think it would be wise to follow the recommendation about a shunt. However, not having examining you and seeing the brain images, it is not possible to give to completely accurate advice. Howver, with an opening pressure of 440 mm I think your ICP is very high. And yes, it can cause damage that is irreversible. The opening pressure is a measurement of the pressure of the fluid that is compressing the brain because the skull does not give way to pressure due to it's stiffness of solid bone. So, as the pressure inside your skull builds up the fluid is pressed against your soft brain. As the pressure builds up, the only structure that
can give way is your brain. This is what causes symptoms, and together with the enlarging cyst, your brain is really being squeezed. Unless you want to undergo multiple LP's (and with the cyst, this wouldn't end the symptoms) I think you are likely stuck with the fact that you need a shunt. You might consider a second opinion, but it sounds like the result will be the same. Best of luck, let us know if we can be of further help.
Sincerely,
CCf Neuro[P] MD, RPS
