Brain cyst — the volume intra cranial education representing the cavity filled with liquid. Often has the hidden subclinical current without increase in the sizes. It is shown generally by symptoms of intra cranial hypertensia and epileptic paroxysms. The focal symptomatology corresponding to a cyst arrangement is possible. It is diagnosed by results of brain MPT and KT, for children of chest age — according to a neyrosonografiya. Treatment is carried out with the progressing growth of a cyst and development of complications, consists in surgical removal or aspiration of a cyst.
Brain cyst — a local congestion of liquid in covers or substance of a brain. The cyst of small volume, as a rule, has a subclinical current, comes to light incidentally at the neurovisualizing inspection of a brain. The cyst of large volume because of limitation of intra cranial (intrakranialny) space leads to intra cranial hypertensia and a sdavleniye of the brain structures surrounding it. Clinically significant size of cysts considerably varies depending on their localization and compensatory opportunities. So, at children of early age, at the expense of a pliability of bones of a skull the long latent course of cysts without symptoms of the expressed likvorny hypertensia is often observed.
The cyst of a brain can be found during various age periods: from a neonatality till advanced age. It should be noted that congenital cysts are more often shown in the middle age (usually in 30-50 years), than in the childhood. It agrees to the standard practice in clinical neurology observant and waiting tactics of maintaining is applied to the stood or slowly progressing cysts of small volume.
Classification of a cyst of a brain
Depending on the location allocate an arakhnoidalny and intracerebral (cerebral) cyst. The first is localized in brain covers and formed at the expense of a congestion of tserebrospinalny liquid in the places of their congenital duplikatura or solderings created as a result of various inflammatory processes. The second settles down in internal structures of a brain and is formed on the site of the brain fabric which died as a result of various pathological processes. Separately allocate also a cyst of shishkovidny gland, a cyst of a vascular texture, colloidal and dermoidny cysts.
All brain cysts are classified by the genesis on congenital and acquired. Treat exclusively congenital a dermoidny and colloidal cyst of a brain. According to an etiology among the acquired cysts distinguish post-traumatic, post-infectious, ekhinokokkovy, postinsultny.
Brain cyst reasons
The factors provoking formation of a congenital cyst of a brain are any adverse effects on a fruit in the antenatalny period. Refer fetoplatsentarny insufficiency, pre-natal infections, reception of the pregnant woman of medicines with teratogenny effect to them, a Rhesus factor conflict, a fruit hypoxia. Congenital cysts and other anomalies of development of a brain can arise if development of a fruit happens in the conditions of pre-natal intoxication at drug addiction, alcoholism, nicotine addiction of future mother, and also in the presence at it chronic dekompensirovanny diseases.
The acquired cyst is formed owing to a craniocereberal trauma, a patrimonial trauma of the newborn, inflammatory diseases (meningitis, an arakhnoidit, abscess of a brain, encephalitis), sharp violations of brain blood circulation (an ischemic and hemorrhagic stroke, subarakhnoidalny hemorrhage). It can have a parasitic etiology, for example, at echinococcosis, a cerebral form of a tenioz, to a paragonimoza the Cyst of a yatrogenny origin can be created as a complication of operations on a brain. In some cases various dystrophic and degenerate processes in a brain are also followed by replacement of cerebral fabrics with a cyst.
The separate group is made by the factors capable to provoke increase in the amount of already available intrakranialny cystous education. As similar triggers injuries of the head, a neuroinfection, inflammatory intra cranial processes, vascular disorders (strokes, difficulty of venous outflow from a skull cavity), hydrocephaly can act.
Brain cyst symptoms
The demonstration of a brain cyst from symptoms of intrakranialny hypertensia is most characteristic. Patients complain of almost constant tsefalgiya, the feeling of a podtashnivaniye which is not connected with food, pressure sense on eyeballs, decrease in working capacity. Sleep disorders, noise or feeling of a pulsation in the head, disorders of sight (visual acuity falling, doubling, narrowing of visual fields, emergence of fotopsiya or visual hallucinations), easy relative deafness, an ataxy (dizzinesses, unsteadiness, a diskoordination of movements), a melkorazmashisty tremor, faints can be noted. At high intra cranial hypertensia the repeating vomiting is observed.
In some cases the cyst of a brain debuts for the first time the arisen epileptic paroxysm which repeated epipristupa follow. Paroxysms can have primary and generalized character, have an appearance of absans or focal dzheksonovsky epilepsy. The focal symptomatology is observed much less often than all-brain manifestations. According to localization of cystous education it includes gemi-and monoparesis, touch frustration, a cerebellar ataxy, stem symptoms (glazodvigatelny frustration, swallowing violation, a dizartriya, etc.).
Its rupture, okklyuzionny hydrocephaly, brain sdavleniye, rupture of a vessel with hemorrhage in a cyst, formation of the resistant epileptogenny center can be a complication of a cyst. Children have cysts which are followed by the expressed intra cranial hypertensia or episindromy, can cause a delay of mental development with formation mental retardation.
Separate types of cysts of a brain
The Arakhnoidalny cyst has congenital or post-traumatic character more often. It is located in brain covers on the surface of a brain. It is filled with tserebrospinalny liquid. According to some information, to 4% of the population have arakhnoidalny cysts of a brain. However clinical manifestations are observed only in case of a big congestion of liquid in a cyst that can be connected with production of a likvor the cages covering a cyst cavity. Sharp increase in the sizes of a cyst threatens with its gap leading to death.
Cyst of shishkovidny gland (pinealny cyst) — cystous formation of an epifiz. Separate data demonstrate that to 10% of people have small asymptomatic pinealny cysts. Cysts with a diameter more than 1 cm are noted much less often and can give clinical symptomatology. At achievement of the considerable sizes, the cyst of shishkovidny gland is capable to block an entrance to a water supply system of a brain and to block a likvorotsirkulyation, causing okklyuzionny hydrocephaly.
The colloidal cyst makes about 15-20% of intra ventricular educations. In most cases settles down in forward area III of a ventricle, over Monroe opening; in some cases — in the IV ventricle and around a transparent partition. Filling of a colloidal cyst differs in big viscosity. The basis of clinical manifestations is made by hydrocephaly symptoms with pristupoobrazny increase of a tsefalgiya at certain provisions of the head. Behavioural frustration, decrease in memory are possible. Cases of emergence of weakness in extremities are described.
The cyst of a vascular texture is formed when filling with tserebrospinalny liquid of space between separate vessels of a texture. It is diagnosed at various age. It is clinically shown seldom, in some cases can give symptomatology of intra cranial hypertensia or epilepsy. Often cysts of vascular textures come to light according to obstetric ultrasonography on the 20th week of pregnancy, then they independently resolve and approximately by 28th week of pre-natal development are not found on ultrasonography any more.
The Dermoidny cyst () is anomaly of an embryonal development at which the cages giving rise to skin and its appendages (hair, nails) remain in a brain. Cyst contents along with liquid are presented by ektoderma elements (hair follicles, sebaceous glands, etc.). Differs in the bystry increase happening after the birth in sizes in this connection is subject to removal.
Diagnosis of a cyst of a brain
The clinical symptomatology and data of the neurologic status allow the neurologist to suspect existence of intrakranialny volume education. For check of hearing and sight the patient goes for consultation of the otolaryngologist and ophthalmologist; the audiometriya, a viziometriya, perimetry and an oftalmoskopiya on which at the expressed hydrocephaly stagnant disks of optic nerves are noted is carried out. The increased intra cranial pressure it is possible to diagnose an echo encephalography with the help. Existence of epileptic paroxysms is the indication to carrying out an electroencephalography. However, being based only on the clinical data, it is impossible to verify a cyst from a hematoma, abscess or a tumor of a brain. Therefore at suspicion on volume formation of a brain application of the neurovisualizing diagnostics methods is necessary.
Use of ultrasonography allows to reveal some congenital cysts even during pre-natal development, after the birth of the child and before closing of his big fontanel diagnostics is possible by means of a neyrosonografiya. Further it is possible to visualize a cyst by means of brain KT or MPT. For a differentiation of cystous education from a brain tumor these researches are conducted with contrasting as unlike a tumor, the cyst does not accumulate in itself contrast substance. For the best visualization of a cystous cavity introduction of contrast to it by a cyst puncture is possible. Unlike MPT, KT of a brain gives the chance to judge viscosity of contents of a cyst on density of its image that is considered when planning surgical treatment. Fundamental value has not only establishment of the diagnosis, but also continuous observation of cystous education for assessment of change of its volume in dynamics. At postinsultny genesis of a cyst in addition resort to vascular inspections: to duplex scanning, UZDG, KT or MRT of vessels of a brain.
Treatment of a cyst of a brain
Conservative therapy is ineffective. Treatment is possible only in the surgical way. However the majority of cysts do not need active treatment as have the small size and do not progress in a size. Concerning them regular dynamic observation by means of MRT-or KT-control is made. The cysts which are clinically shown hydrocephaly symptoms, progressively increasing in a size, complicated by a gap, bleeding, a brain sdavleniye are subject to neurosurgical treatment. The choice of a method of operation and surgical approach is carried out on consultation of the neurosurgeon.
In cases of serious condition of the patient with disorder of consciousness (a sopor, a coma) in the emergency order external ventrikulyarny drainage for reduction of intra cranial pressure and a sdavleniye of a brain is shown. In case of development of complications in the form of a rupture of a cyst or hemorrhage, and also at a parasitic etiology of a cyst surgical intervention is carried out for the purpose of radical excision of cystous education; surgical access is cranial trepanation.
In other cases operation has planned character and is carried out in mainly endoscopic way. Advantage of the last is small injury and the shortened recovery period. Its implementation requires only a frezevy opening in a skull through which aspiration of contents of a cyst is carried out. For the purpose of the prevention of a repeated congestion of liquid in a cystous cavity a number of the openings connecting it to likvorny spaces of a brain is made or kistoperitonealny shunting is performed. The last assumes implantation of the special shunt on which liquid from a cyst comes to an abdominal cavity.
In the postoperative period complex rehabilitation therapy in which if necessary the neuropsychologist, the doctor of LFK, the massage therapist, the reflexologist take part is carried out. The medicamentous component includes the rassasyvayushchy means, medicines improving blood supply and metabolism of a brain, antiedematous and symptomatic medicines. In parallel with the purpose of restoration of muscular force and sensitive function, adaptation of the patient to physical activities, the physical therapy, LFK, massage, reflexotherapy is carried out.
Forecast and prevention of a cyst of a brain
Clinically insignificant stood brain cyst in most cases keeps the not progressing status and does not disturb the patient during life in any way. Timely and adequately carried out surgical treatment of clinically significant cysts causes their rather favorable outcome. The residual moderately expressed likvorno-gipertenzionny syndrome is possible. In case of formation of focal neurologic deficiency it can have resistant residual character and remain after the carried-out treatment. Often passes epileptic paroxysms after removal of a cyst, but then often renew that is caused by formation of solderings and other changes of the operated area of a brain. At the same time secondary epilepsy differs in resistance to the carried-out antikonvulsantny therapy.
As the acquired brain cyst often is one of options of permission of infectious, vascular, inflammatory and post-traumatic intrakranialny processes, its prevention is timely and correct treatment of the specified diseases with application of neurotyre-tread and rassasyvayushchy therapy. Concerning congenital cysts as prevention serves protection of the pregnant woman and a fruit from influence of various harmful factors, correct conducting pregnancy and childbirth.