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Choroidal fissure cyst

A choroidal fissure cyst refers to a benign intracranial cyst occurring at the level of choroidal fissure. They frequently represent either an arachnoid cyst, neuroglial cyst or a neuroepithelial cyst 2. They are therefore a location based diagnosis rather than a distinct pathological entity.

Clinical presentation

They are usually asymptomatic and discovered incidentally. Very rarely they may cause seizures of mass effect within the temporal lobe 3.

Radiographic features

General

They are usually small and range around about one two centimeter in diameter. Occasionally, larger cysts may be seen. The cysts are usually quite round on axial and coronal scans, with a characteristic spindle or ovoid shape paralleling the long axis of the temporal lobe and choroid fissure on sagittal images.

CT brain

CT scans show a well-delineated homogeneous low density mass with attenuation characteristics similar to CSF. Calcification and contrast enhancement are absent.

MRI brain

MR signal characteristics are similar to CSF on all sequences. The cyst walls are thin. Contrast enhancement, surrounding oedema and gliosis are absent.

Treatment and prognosis

They are almost always benign with interval follow up (not required) showing no imaging changes. As such no treatment is required 1.

Differential diagnosis

General imaging differential considerations include

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