Arachnoid cyst in the fetus. Arachnoid cyst of the brain: why in such a situation it is impossible to delay treatment? What does dizziness and numbness of the tongue mean?

An arachnoid cyst is a benign neoplasm with liquid contents in the brain. It got its name from its location in the arachnoid membrane of the brain. There is a place in the brain where the membrane bifurcates, forming a small gap. Fluid can accumulate along this narrow fissure (closer to the posterior fossa or cerebellum).

The disease is more common in men than in women. Arachnoid cysts are diagnosed in approximately 3.5% of the world's population. With a small tumor size, it can occur completely without any symptoms and be diagnosed by chance, during an examination of the head for another reason.

What is the danger of a retrocerebellar arachnoid cyst?

A long asymptomatic course of the disease in combination with the slow growth of the cyst is in itself dangerous. Parents may not realize that their child has a tumor in the brain. Although the tumor is benign, if left untreated it can have life-threatening complications. For example, one of these complications is the rupture of a cyst, in which the cerebrospinal fluid filling it spills into the brain tissue, which leads to death.

In addition, no one can give an absolute guarantee that the tumor will not degenerate into malignant. And this is already a serious danger to life.

Main types of disease

The main classification of this type of cyst is based on the principle of tumor localization. So, depending on the depth of location, two types are distinguished:

• a simple arachnoid cyst, which forms closer to the surface of the brain;
• retrocerebellar arachnoid cyst, which forms deep in the gray matter; At the site of the formation of such a cyst, gray matter cells die.

There are several localizations of this tumor in the brain:

• interhemispheric cyst - formed between the cerebral hemispheres;
• posterior fossa cyst;
• cyst of the frontal and parietal part;
• temporal lobe (right or left, symptoms are different);
• pineal gland cyst;
• cerebellar cyst (inside, on or near the cerebellum).

In addition, there is a gradation based on origin:

• Primary cyst - formed in the prenatal period; the cause of the appearance is usually an infection suffered by a pregnant woman;
• Secondary – formed as a result of external influence (trauma, infectious disease of the brain, complication after surgery, hemorrhage).

An arachnoid cyst can be simple or complex in composition. In a simple cyst, liquor fluid completely fills its cavity, but in a complex cyst there may be other cells inside, and the tumor itself can spread to adjacent tissues.

If the cyst increases in size, it is called progressive. If the cyst does not grow, it is considered frozen. Depending on the course of the disease, the doctor chooses the method of treating it.

Symptoms and signs

The disease manifests itself differently depending on the size of the tumor. If it is small (up to 2 cm), symptoms may be absent for several years or even a lifetime. As the cyst grows, it puts pressure on a certain area of ​​the brain, which causes neurological symptoms in the patient and suppression of the functions of those organs for which the area of ​​the brain affected by the tumor is responsible.

If a cyst is present in young children, the children are developmentally delayed, restless, tearful, and have trouble falling asleep. They begin to experience visual and hearing impairments. It is very difficult to detect signs of a brain cyst in infants and younger preschoolers, since they are not yet able to describe their sensations in words. But even at an older age, diagnosing an arachnoid cyst is not easy. And not only among preschoolers, primary schoolchildren, teenagers, but even among adults.

Parents need to know the most common manifestations of an arachnoid cyst. These include:

• nausea, vomiting;
• headache;
• constant drowsiness;
• the feeling of fatigue and weakness that does not leave the child;
• convulsions.

At later stages, other unpleasant sensations are added:

• difficulties with coordination of movements, maintaining balance, unsteadiness of gait;
• feeling of heaviness in the head;
• hearing loss;
• decreased visual acuity, visual disturbances: double vision, dark spots in the eyes;
• visions in the form of hallucinations;
• difficulty moving limbs (paresis);
• loss of consciousness.

Arachnoid cyst of the brain in newborns

Signs of the disease in infants will differ from those in more “adults”. You need to pay special attention to the baby’s condition if you notice:

• muscle weakness, immobility of arms and legs;
• swelling, pulsation of the fontanel;
• regurgitation after feeding in the form of a fountain;
• child's restlessness;
• the child does not stop his gaze on objects.

1-2 years of life

A cyst in young children can be either congenital (not previously diagnosed) or acquired as a result of infections.

Often the disease occurs without neurological symptoms. However, this does not always happen. The child may experience a whole range of uncomfortable symptoms.

A tumor in the brain can cause developmental delays in children. Their movements are less coordinated and it is more difficult for them to learn new skills.

Schoolchildren

The causes of cysts in schoolchildren are most often associated with head injuries, inflammatory or infectious diseases such as meningitis, encephalitis.

If the cyst grows, the child may have headaches, nausea, numbness in body parts and other characteristic symptoms. Memory may deteriorate, behavior becomes more irritable.

Children of all ages need the supervision of a neurologist who will decide what measures to take and prescribe the appropriate treatment.

Diagnostic methods

The difficulty in identifying the disease is that the symptoms are largely similar to those of other diseases. In the case of a cyst in a child, especially an infant, it is not possible to identify it based on a simple survey. Modern examination methods are designed to ensure diagnostic accuracy. MRI of the brain, ultrasound, computed tomography, electroencephalography, echo and rheoencephalography are performed. The most informative method in making an accurate diagnosis is MRI - magnetic resonance imaging. With its help, the doctor can not only determine the presence of a tumor, find and accurately determine its location, but also understand the nature of the tumor.

How to treat correctly

If the cyst does not increase in size, it does not bother the patient. However, it is better for him to be under the supervision of a doctor: the neoplasm requires constant monitoring, even when frozen. If the disease does not progress, treatment with medications is indicated.

When the cyst enlarges and neurological symptoms increase, an operative (surgical) method of treatment is used.

Drug treatment

Even if nothing bothers the patient, treatment is carried out to prevent the growth of the tumor. As a rule, these are antiviral agents, drugs for strengthening the immune system, improving blood supply and nutrition of brain tissue, as well as resolving adhesions.

Surgical intervention

Surgery is required in all cases of cyst growth in width and length, because this creates the preconditions for suppression of the functions of various brain centers and can be life-threatening.

There are three types of surgeries used to get rid of an arachnoid cyst:

• Bypass;
• Neurosurgical operation (cyst excision);
• Endoscopy.

The most gentle method is endoscopic, in which the contents of the cyst are removed through a narrow hole with a diameter of up to 2 cm.

Prognosis for the patient

The prognosis for the patient is favorable. After surgery, patients recover within several weeks, in some cases up to several months. But if the cyst is not treated, it can cause complications in the form of constant severe headaches and even epileptic seizures. The danger of degeneration into cancer has already been mentioned above.

Parents need to know: a child with an arachnoid cyst can make a full recovery. A timely diagnosis, compliance with doctors’ recommendations, as well as your patience and love for your child play a big role.

Preventive actions

An arachnoid cyst in a child is a preventable disease. You need to take care of this before the birth of the child, and even better - before pregnancy.

Future parents should try to maintain a healthy lifestyle. Fresh air, physical activity, a balanced diet, absence of bad habits - all this will contribute to the health of your family members for many years.

When your baby is born, all of these health fundamentals will need to be applied to him. A child of any age needs proper nutrition, physical education, walks, feasible exercise and, of course, positive communication with parents and loved ones.

Shoshina Vera Nikolaevna

Therapist, education: Northern Medical University. Work experience 10 years.

Articles written

Arachnoiditis of the brain is a disease in which neoplasms (), spherical in shape, filled inside with liquor fluid, begin to appear in the membranes of the brain tissue.

The appearance of such formations is a pathological process that occurs almost asymptomatically. Arachnoid (small) brain is diagnosed mainly by chance - during an examination prescribed by a specialist and associated with the identification of other pathologies. Unpleasant consequences and complications occur only if the tumor begins to increase in size, which inevitably leads to pressure on the brain tissue. This is when warning signs and symptoms appear.

Arachnoid changes are classified as follows:

1. A. The cyst is located between the meninges. According to statistics, such neoplasms are more common in men. If the formation does not increase over time and its size remains unchanged, it is enough for the patient to be periodically observed by a specialist. When a tumor appears, the child may develop hydrocephalus and the size of the skull may increase.
2. A subarachnoid cyst of the brain is a congenital pathological formation that can only be discovered by chance. Symptoms that may alert you: periodic pulsation felt inside the skull, unsteady gait, the appearance of convulsions.
3. Retrocerebellar form. This type of cyst is characterized by the formation of a bubble not between the membranes of the brain, but in the brain tissue itself. The reason for the appearance of such a neoplasm can be: a previous stroke, impaired blood supply to the brain, or encephalitis. This type of neoplasm can lead to serious consequences. The neoplasm is dangerous because over time it begins to gradually destroy brain tissue, which gradually dies.
4. Arachnoid cerebrospinal fluid cyst. This pathology begins to develop in elderly patients suffering from atherosclerotic changes.

Arachnoid cysts (of different types) of the brain can be divided into the following subtypes:

• congenital (primary) form. This pathology occurs in children during intrauterine development. A brain cyst in newborns can also appear if the birth was difficult, the child became entangled in the umbilical cord, and oxygen did not reach the brain for some time. It is in such cases that the baby may be at risk of such a disease;
• secondary form. Such a neoplasm can occur in both adults and children due to a number of negative factors: brain surgery, various head injuries, viral infections, exposure to radiation, age-related changes (arachnoid cerebrospinal fluid cyst (in older people) of the brain).

Experts distinguish two types of formations:

1. Progressive type of cyst. The arachnoid formation gradually increases in size, interfering with the patient’s normal life. The disease has a number of specific symptoms and requires immediate treatment.
2. Frozen type of cyst. The tumor does not change its size over time, does not cause the patient any discomfort, and does not affect the patient’s quality of life. Such a diagnosed pathology does not require special treatment; it is enough just to be periodically observed by a specialist.

The structure of the neoplasm itself is also divided into two types:

1. Simple cyst. The tumor is filled with cerebrospinal fluid.
2. Complex cyst. The neoplasm consists not only of liquorocystic material, but is also supplemented with various tissues.

The location of the formation directly affects the classification; specialists diagnose arachnoiditis in the following places:

• neoplasm developing in the spinal canal;
• posterior fossa cyst;
• a cyst developing in the temporal lobe of the brain;
• neoplasm arising in the lumbar region;
• formation in the crown and so on.

Treatment of arachnoiditis directly depends on the correct classification of the disease.

Factors that may influence cyst growth

A brain cyst in a child or adult may begin to increase in size under the influence of the following factors:

• inflammatory processes of the membranes of the brain caused by infections or viruses;
• increased pressure of the liquor fluid located inside the neoplasm;
• any mechanical (severe bruises, surgery).

Causescystic formation in infants

The primary form of the neoplasm may appear in a child due to the influence of the following factors on the expectant mother’s body:

• the pregnant woman took certain types of medications that affect the development of the pathology;
• the expectant mother was exposed to radiation;
• toxic substances entered the body of a pregnant woman, which led to poisoning;
• the expectant mother abused bad habits (drank alcohol, smoked).

Symptoms of pathology

It is known that, according to statistics, more than 80 percent of such neoplasms have virtually no symptoms; arachnoiditis, which is accompanied by neurological symptoms, is observed only in the remaining twenty percent.

In most cases, cystic formations are discovered in the patient during an examination that is in no way related to the diagnosis of the pathology. All symptoms of the disease are vague and depend entirely on the size and location of the tumor. Only as the cyst grows, the patient may experience the following unpleasant sensations:

• the appearance of sudden dizziness (in the absence of other factors: pregnancy, extreme fatigue, lack of iron in the body, taking certain medications);
• sudden vomiting, attacks of nausea (in the absence of other factors: poisoning, effects of certain medications on the body, expecting a child, viral diseases with such symptoms);
• mental disorder, the appearance of hallucinations;
• convulsive conditions;
• sudden loss of consciousness;
• the appearance of a feeling of numbness in the arms and legs;
• a sharp headache accompanied by throbbing or a feeling that the head is bursting from the inside;
• impaired coordination of movements;
• a feeling of heaviness in the head;
• hearing disorders, appearance;
• visual disturbances;
• the occurrence of severe pain in the head during sharp turns and bends.

Diagnostic methods

Due to the fact that the symptoms of this pathology are in many ways similar to other diseases, an arachnoid cyst should be diagnosed in several ways, these include:

• laboratory research,
• instrumental method.

The brain is the main way to diagnose pathology. Carrying out such an examination allows you to notice even a small cystic formation in the image, observe a frozen type neoplasm, and monitor the enlargement of the cyst during its growth.

But the main thing for a specialist when diagnosing a neoplasm is to discover the reasons that caused its appearance or growth.

It is to identify the causes that the following examinations are prescribed:

1. Dopplerography of blood vessels. A study to determine the degree of vascular patency. With the help of research, a specialist will be able to find out whether there are any disturbances in the blood supply system and how brain activity proceeds.
2. Blood tests: cholesterol, clotting.
3. Tests that detect the presence of infectious diseases in the patient’s body.
4. Measuring blood pressure throughout the day. Due to the fact that one of the reasons for the increase in education is a sharp increase in blood pressure.
5. Study of the patient's cardiac activity.

TreatmentcysticXeducationth

Arachnoiditis and its treatment require accurate diagnosis. If the neoplasm is of the frozen type, does not produce painful symptoms, and its presence is normal for the patient, then the main task of the specialist is:

• establishing the root cause of the cyst,
• education supervision,
• prevention and elimination of any factors that can cause the appearance of new formations.

A progressive type of neoplasm requires careful diagnosis aimed at identifying the cause of the appearance and rapid growth, and complex treatment aimed at eliminating the causes contributing to the growth of the cystic formation, and in some cases, surgical removal.

In the treatment of pathology, medication is also used. The patient is prescribed a number of drugs that help:

• relieving inflammation processes occurring in the body;
• normalization of brain activity;
• normalization of the permeability of vascular walls;
• normalization of blood pressure;
• restoration of damaged brain tissue.

The ineffectiveness or low effectiveness of drug treatment requires taking radical measures: it is in this case that treatment such as surgery is considered.

Indications for which a cyst is surgically removed:

• if there is a possibility of tumor rupture;
• when diagnosing the deteriorating mental state of the patient (frequently recurring epileptic seizures, frequent occurrence of convulsions);
• if intracranial pressure constantly increases;
• with increased focal symptoms.

Today, several methods of surgical intervention are used:

1. Excision of the tumor (). The most traumatic method of surgical intervention, because when it is carried out, not only the cyst itself is removed, but also all the tissues located next to it.
2. Drainage of cystic formation. The technique allows you to remove liquor fluid from the cyst using needle aspiration.
3. Shunting. During this intervention, the specialist inserts a special device (shunt) into the formation to drain the substance accumulated in the cavity.

Forecasts and preventive measures

Cystic formations of the brain can have a different course. In most cases, the tumor does not bother the patient throughout his life. Only progressive forms of arachnoid cysts are dangerous. If the pathology is detected too late, the patient may experience serious complications leading to disability and even death. Timely diagnosis and proper treatment can completely eliminate the problem. Unfortunately, there is a possibility of relapse of the disease, threatening new complications.

Preventive measures to prevent the development of neoplasms in the subarachnoid space of the brain in newborns are:

• correct behavior of a woman during pregnancy, excluding self-administration of medications without a doctor’s prescription,
• giving up bad habits during the child’s prenatal development (alcohol, cigarettes),
• Observance by pregnant women of safety rules that exclude harmful effects on the unborn child.

Preventive measures for acquired tumors include:

• specialist supervision,
• timely treatment of inflammatory processes, vascular diseases, brain injuries.

What is an arachnoid cyst? How dangerous is it to human life? In the thickness of the membranes that cover the brain, a benign sphere is formed and filled with cerebrospinal fluid. This is an arachnoid cyst of the brain.

It is so called because of the dislocation of the sphere, since the accumulation of cerebrospinal fluid in it occurs between two layers of the thickened arachnoid membrane. The brain has only three of them. The arachnoid is located between the other two - hard superficial and soft deep.

Frequent locations of the cyst are the Sylvian fissure, the cerebellopontine angle or the area above the sella turcica and other areas. The development of the liquor sphere is more often observed in children and male adolescents.

In children, arachnoid cysts of the brain are predominantly congenital and form in the embryonic stage during the formation of the central nervous system. It accounts for 1% of volumetric neoplasms inside the skull due to disturbances in liquor circulation.

Small spheres may not appear during life. As the cyst grows after it begins to form, the flow of fluid through the brain is blocked and hydrocephalus develops. When compression (pressure) is applied to the cerebral cortex, clinical symptoms appear, hernias may form or sudden death may occur.

The ICD-10 code for arachnoid cyst (AC) is G93.0.

According to anatomical and topographical characteristics, cysts of the cerebral hemispheres include:

• AC of the lateral (Sylvian) fissure;
• parasagittal (parallel planes) AC;
• convexital medullary surface.

Mid-basal formations include cysts:

• arachnoid intrasellar and suprasellar;
• cisterns: covering and quadrigeminal;
• retrocerebellar arachnoid;
• arachnoid cerebellopontine angle.

Cysts are formed differently, so they are divided by type. There are AKs:

1. True or isolated.
2. Diverticular or communicating. Disturbed cerebrospinal fluid dynamics at the end of embryo development leads to the formation of cysts.
3. Valved or partially communicating. This development is associated with productive changes in the arachnoid membrane.

The generally accepted classification (according to E. Galassi - 1989) is also used to separate the most common ACs of the lateral fissure (LS);

• Small type 1 cysts are bilateral, located at the pole of the temporal lobe, and do not appear. CT cisternography with contrast agent shows that the cysts communicate with the subarachnoid space;
• Type 2 cysts are located in the proximal and middle parts of the thyroid gland and have an oval shape due to an incompletely closed contour. They partially communicate with the subarachnoid space, as can be seen on spiral computed tomography with contrast agent;
• Type 3 cysts are large and therefore located throughout the Sylvian fissure. This significantly shifts the midline, raises the lesser wing of the main bone and the scales of the temple bone. They communicate minimally with the cerebrospinal fluid system, as shown by CT cisternography with contrast.

There are two types of arachnoid cyst of the brain:

• primary (congenital) due to abnormal development of the meninges under the influence of drugs, radiation exposure, toxic agents and physical factors;
• secondary (acquired) in connection with various diseases: meningitis, agenesis of the corpus callosum. Or due to complications after injury: bruises, concussions, mechanical damage to the hard surface shell, including surgery.

Based on its composition, the cyst is divided into: simple, since it is formed from cerebrospinal fluid (CSF), and complex sphere, consisting of cerebrospinal fluid and various types of tissue.

AK forms on the head in the area:

• left or right temporal lobe;
• crown and forehead;
• cerebellum;
• spinal canal;
• posterior cranial fossa.

Perineural cysts are also found in the spine and in the lumbar region.

Symptoms

Asymptomatic small AKs are discovered incidentally during examination for another reason. Symptoms become more pronounced with growth and depending on the location of the cyst, compression of tissues and brain matter. The manifestation of focal symptoms occurs against the background of the formation of a hygroma or when the aortic valve ruptures.

As the formations progress, adults lose orientation and sleep. They complain of uncomfortable conditions in which muscle tone is disturbed, limbs twitch involuntarily and go numb, and lameness occurs. I regularly experience tinnitus, migraines, nausea with vomiting, and often feel dizzy and even lose consciousness. Also in patients:

• hearing and vision are impaired;
• hallucinations and convulsions occur;
• the psyche is upset;
• “bursting” inside the head and the pulse is felt;
• Pain under the skull intensifies when moving the head.

A secondary (acquired) cyst complements the clinical picture with manifestations of the underlying disease or injury.

This is the basis for a full examination of the baby at the medical center.

Diagnostics

When establishing a diagnosis, clinical, neuroimaging and neurophysiological data are compared. The child should be examined by a neurologist, ophthalmologist, pediatrician, and geneticist. The diagnosis is confirmed by the following clinical manifestations:

• local changes: bone deformation of the cranial vault, especially in infants under one year of age;
• symptoms indicating intracranial hypertension, in which the fontanelle is tense and bone sutures diverge in children under one year of age;
• lethargy, drowsiness, vomiting, headache, pyramidal symptoms;
• neuro-ophthalmological symptoms arising in connection with mechanocompression of the interpeduncular and chiasmatic cistern, compression of the optic nerves by the lateral fissure cyst;
• dysfunction of the oculomotor nerves, chiasmal syndrome, decreased vision, atrophy and congestion in the fundus;
• neuroimaging signs: one or more ACs are found in the cerebrospinal fluid, causing pathosymptoms.

In newborn babies and infants, a screening method (NSG - neurosonography) of the brain is used. Spiral computed tomography (SCT) is also recommended. An MRI is mandatory, but if the data is questionable, it is double-checked with a contrast agent and the CISS test and heavily T2-weighted images are used for diagnosis.

MRI examines the craniovertebral region to exclude associated anomalies: Arnold-Chiari, hydromyelia. The anesthesiologist examines patients, preparing them for surgery and assessing the degree of risk of the operation. If the surgical and anesthetic risk is large, then methods of preoperative management of patients are being prepared. Examinations are carried out by related specialists to determine concomitant diseases and their degree of development. At the same time, existing violations are corrected and patients are additionally examined:

• Blood tests reveal (or exclude) viruses, infections, and autoimmune diseases. They also determine clotting and bad cholesterol;
• The Doppler method is used to detect obstructions in the patency of arteries, which leads to a lack of blood supply to the brain.

The heart function is checked and blood pressure is measured throughout the day.

Treatment

According to the dynamics of development, cysts are frozen and progressive. Frozen cysts are not treated unless they cause pain or other uncomfortable symptoms. In these cases, underlying diseases are identified and treated, which stimulate the development of AK.

To eliminate the inflammatory process, normalize blood flow to the brain, restore damaged cells, cope with medium-sized cysts, you should be treated, for example, with means for:

• resorption of adhesions: “Longidaz”, “Karipatin”;
• activation of metabolic processes in tissues: “Actovegin”, “Gliatilin”;
• increasing immunity: “Viferon”, “Timogen”;
• getting rid of viruses: “Pyrogenal”, “Amiksin”.

Important. Treatment of an arachnoid cyst should only be carried out as prescribed by a doctor. You cannot exceed or reduce the dosage of medications or cancel treatment on your own, so as not to aggravate the inflammatory process and provoke cyst growth.

Surgical operations

Absolute indications for neurosurgical treatment for AK with cerebrospinal fluid or hydrocephalus include:

• hypertension syndrome (increased intracranial pressure);
• increasing neurological deficit.

Relative indications are:

• large asymptomatic AK, since it deforms the adjacent lobes of the brain;
• AK LS with progressive growth and causing disruption of the circulation of cerebrospinal fluid due to deformation of its pathways.

Important. It is contraindicated to carry out surgical treatment in a decompensated state of vital functions (unstable hemodynamics, breathing), coma III, extreme exhaustion (cachexia), and with an active inflammatory process.

When using surgical treatment, craniocerebral disproportion is eliminated. For this purpose, liquor shunting, microsurgical, and endoscopic operations are used. Intraoperative ultrasound and neuronavigation are prescribed to achieve safe manipulation.

To determine the tactics of the operation, the shape and size of the AC, the estimated accessible area, the trajectory of movement, and possible complications are taken into account, since during the operation, vascular-neural structures may be damaged, a hyperdrainage state may occur, an outpouring of blood and cerebrospinal fluid, and if the cyst ruptures, an infection can occur. A histological examination of the contents of the cyst and its walls is carried out.

When prescribing liquor shunt operations, for example, cystoperitoneal shunting, the surgeon achieves the goal of draining the cyst in a cavity outside the brain with minimal damage. However, it is necessary to implant an artificial drainage system, which is considered a disadvantage of this treatment method. If the circulation of cerebrospinal fluid is impaired, having a hypo- or aresorptive nature, it is combined or provoked by giant AKs. Then liquor shunt operations are the main methods of treatment.

Microsurgical surgery is used to eliminate type 2 AK. In this case, a large craniotomy is not performed. It is performed only on the temporal bone close to the base, that is, in the area of ​​the scales. If there is a convexital location - at its most protruding part. Ultrasound navigation is used to determine the area of ​​craniotomy.

Treatment with the endoscopic method is carried out for patients with the presence of symptoms of AK, especially types 2–3 LS. Endoscopic surgery is possible only if the clinic has a full set of rigid endoscopes with different viewing angles, illumination, a digital video camera, a saline irrigation system, bi- and monopolar coagulation.

Complications

After surgery, cerebrospinal fluid may leak, which is called liquorrhea. Necrosis of the edge of the skin flap and wound dehiscence after surgery are possible, so a revision of the incision is prescribed. If resorption is impaired, peritoneal shunting of the cyst is performed. Cysts and hydrocephalus of the brain are also corrected to ensure favorable treatment outcomes for patients, especially young children.

Surgical correction of hydrocephalus is performed before removal of cysts in cases of severe hydrocephalic-hypertensive syndrome: Evans index > 0.3, periventricular edema of the optic nerve, disorder of consciousness and children under one year of age.

After the operation, patients are under medical supervision. In the presence of type 1 AK, children are monitored so as not to miss neurological and neuro-ophthalmological symptoms. SCT/MRI (spiral and magnetic resonance computed tomography) is monitored at least once a year for 3 years. Patients are examined by neurosurgeons, neuropsychologists, neurologists, pediatricians, ophthalmologists, and neurophysiologists.

Change in gait

Fluctuations in blood pressure

Impaired concentration

Disorientation in time

Balance imbalance

Feeling of pulsation in the head

Tingling in the limbs

Decreased vision

Deterioration of orientation in space

Partial paralysis of limbs

Arachnoid cyst (syn. liquor cyst) is a neoplasm with a benign course localized either in parts of the brain or in the cavity of the spinal canal. A person can get sick at any age.

One of the main factors in the formation of pathology is burdened heredity. The cause may be frequent injuries to the skull or spinal column, extensive internal hemorrhages, a sedentary or, conversely, overly active lifestyle.

The severity of symptoms is influenced by many factors, but the most important is the size of the tumor. The main clinical signs are considered to be pain, paresis of the lower and upper extremities, and changes in gait.

Only a neurologist can make a final diagnosis, using the results of instrumental examinations as a basis. Auxiliary diagnostic measures are laboratory tests and manipulations performed directly by the clinician.

Treatment of pathology in adults and children is carried out only through surgical intervention. However, for small volumes of cystic formation, clinicians use conservative treatment methods.

In the international classification of diseases, the problem is assigned several meanings, differing in the location of the neoplasm. For example, an arachnoid cyst of the brain has ICD-10 code G93.0, and an arachnoid cyst of the spine has code D32.1.

Etiology

A neoplasm filled with cerebrospinal fluid (CSF) is included in the group of rare pathological processes, since only 5% of people on Earth live with such a diagnosis.

In most situations, the causes of the disease are represented by the following factors:

• intrauterine anomalies of fetal development;
• the course of the inflammatory process in the brain in the Sylvian fissure;
• any conditions leading to increased intracranial pressure;
• frequent head injuries;
• previous and other cardiovascular pathologies;
• medical intervention performed on the brain;
• bleeding in the brain, especially extensive;
• the occurrence of infections that negatively affect the functioning of the central nervous system;
• long-term unhealthy lifestyle;
• long-term influence of unfavorable environmental conditions on the human body;
• complicated gestation or labor - most often leads to the development of the disease in children;
• oxygen starvation of brain tissue;
• degenerative changes in the brain.

An arachnoid cyst of the posterior cranial fossa or other area of ​​the brain is characterized by a slow increase in size. However, there are several negative factors that can provoke the growth of a tumor:

• diseases of an autoimmune nature;
• chronic heart disease;
• subdural hematomas;
• neuroinfections.

An arachnoid cyst of the spinal cord or spine often results from the following processes:

The formation is secondary in nature, but practically not prone to malignancy. It is worth considering that clinicians do not exclude the possibility of the influence of genetic predisposition.

Classification

Based on the etiological factor, arachnoid cysts of the brain, lumbar region and other areas of the spine can be:

• congenital - refers to malformations of the brain or spinal cord;
• acquired - a consequence of the influence of one of the unfavorable provocateurs.

The division according to the morphological structure of the wall of the cystic formation suggests the existence of the following types of foci:

• simple or true tumor - the cavity of the pathological neoplasm is lined with arachnoid membranes, which can produce cerebrospinal fluid (CSF);
• complex or false tumor - the lining consists of other tissues.

According to clinical signs, a neoplasm localized in the head or spine is:

• progressive - there is an increase in the volume of the cyst, which provokes a clear manifestation of symptoms;
• frozen - does not increase in size and is often asymptomatic.

Tumors of the spinal column are divided into several types:

• perineural arachnoid cyst (congenital) - occurs in 7% of cases;
• periarticular cyst - formed in the area of ​​the facet joints;
• aneurysmal cyst - localized inside the bone and filled with venous blood;
• retrocerebral cyst - a cavity that is filled with cerebrospinal fluid.

Based on the focus of the pathological process, the following are distinguished:

• arachnoid cyst of the sacral spine;
• damage to the cervical, thoracic and lumbar segments.

Brain damage has its own forms, which is why clinicians define the following types of disease:

• arachnoid cyst of the left temporal lobe - occurs several times more often than lesions of the right temporal lobe;
• posterior fossa cyst;
• arachnoid cyst of the cerebellum or cerebellar angle;
• cyst of the parietal region;
• Sylvian fissure cyst;
• sella cyst;
• convexital cyst;
• arachnoid cerebrospinal fluid cyst of the brain.

Symptoms

The severity of clinical signs is influenced by the volume of the tumor. In some cases, symptoms may be completely absent, but this only happens when a frozen cyst develops. The correct diagnosis in such cases is made by chance - pathology acts as a diagnostic discovery.

An arachnoid cyst of the temporal lobe on the left or right, as well as tumor localization in other parts of the brain, has the following symptoms:

• severe headaches;
• constant nausea without vomiting;
• paralysis and paresis of the arms or legs;
• hearing loss;
• change in gait;
• problems maintaining balance;
• decreased visual acuity;
• loss of skin sensitivity in limbs;
• disturbance of orientation in time and space;
• insomnia;
• pulsation in the temporal region;
• rapid fatigue and decreased performance;
• attention disorder;
• deterioration of thinking;
• attacks of dizziness;
• frequent mood changes;
• fainting conditions;
• hallucinations.

Damage to the spinal column is expressed by the following symptoms:

• sharp or dull pain in the damaged part of the spine;
• dizziness and;
• tingling and numbness of the skin of the hands and feet;
• problems with bowel and bladder movements;
• lameness;
• backs;
• muscle weakness and paresis of the limbs;
• fluctuations in blood tone indicators;
• problems swallowing food;
• and nausea;
• decreased ability to work

An arachnoid tumor of the spine or a brain cyst in a child is represented by the following symptoms:

• weakness and fatigue;
• lethargy of the upper and lower extremities;
• pulsation and swelling of the fontanel;
• sleep disturbance;
• increased tearfulness;
• frequent regurgitation;
• constant anxiety;
• disorientation of gaze;
• change in head size - the age norm can be exceeded several times;
• seizures;
• hearing loss.

The clinical picture will always be individual.

Diagnostics

To make a correct diagnosis, it is necessary to carry out a number of instrumental examinations, but such procedures must necessarily be preceded by primary diagnostic manipulations performed directly by a neurologist:

• familiarization with the medical history of both the patient and his relatives - to identify the etiological factor with a pathological or genetic basis;
• life history analysis;
• collecting information about the period of pregnancy;
• thorough physical and neurological examination;
• determination of hearing and visual acuity;
• measurement of head volumes and blood pressure indicators;
• a detailed survey of the patient or his parents - to draw up a complete clinical picture of the course of the anomaly.

An arachnoid cyst of the brain or any part of the spine can only be detected using the following instrumental procedures:

• CT and MRI of the spinal column;
• Doppler scanning of the vessels of the back of the head;
• ECG and EchoCG;
• 24-hour blood pressure monitoring;
• radiography using a contrast agent;
• Ultrasound and SCT of the brain;
• electroencephalography;
• echoencephalography;
• rheoencephalography;
• angiography of blood vessels using a contrast agent.

Laboratory diagnostic measures are of auxiliary importance: only general clinical and biochemical blood tests are prescribed.

Treatment

Treatment is carried out using surgical techniques. However, the use of conservative methods of therapy is indicated for small tumors.

Conservative therapy:

• bed rest;
• injection of painkillers and anti-inflammatory drugs;
• use of means to improve blood microcirculation;
• the use of painkillers;
• balanced diet - the menu should contain a sufficient amount of vitamins, proteins and beneficial microelements;
• physiotherapeutic procedures, for example, medicinal phonophoresis, ultrasound, acupuncture and laser therapy;
• therapeutic massage course;
• wearing special corsets and bandages - only necessary if the back is affected;

As for surgical intervention, treatment is carried out using the following methods:

• neurosurgical operation;
• brain shunt;
• endoscopic procedures on the skull or spinal column;
• laser excision of formation.

After surgery, patients require long-term rehabilitation.

Possible complications

The formation of an arachnoid cyst is fraught with the development of the following complications:

• increase in tumor size;
• seizures;
• chronic headaches;
• rupture of pathogenesis with subsequent blood poisoning;
• retardation of children in physical and mental development;
• extensive internal bleeding;
• disability.

Prevention and prognosis

To prevent an arachnoid tumor of the spine or a brain cyst from occurring in newborns, general preventive measures must be followed, since specific recommendations have not been developed to date.

If you are looking for information on the topic “cyst in the brain” or an answer to the question “what is a cyst in the brain?”, then this article is for you. A cyst in the brain, or more precisely, an arachnoid cerebrospinal fluid cyst, is a congenital formation that arises during development as a result of splitting of the arachnoid (arachnoid) membrane of the brain. The cyst is filled with cerebrospinal fluid - a physiological fluid that washes the brain and spinal cord. True congenital arachnoid cysts should be distinguished from cysts that appear after damage to the brain due to traumatic brain injury, infection, or surgery.

Arachnoid cyst ICD10 code G93.0 (cerebral cyst), Q04.6 (congenital cerebral cysts).

Classification of arachnoid cerebrospinal fluid cyst.

By location:

1. Sylvian fissure arachnoid cyst 49% (the fissure formed by the frontal and temporal lobes of the brain), is sometimes called a temporal lobe arachnoid cyst.
2. Arachnoid cyst of the cerebellopontine angle 11%.
3. Arachnoid cyst of the craniovertebral junction 10% (junction between the skull and the spine).
4. Arachnoid cyst of the cerebellar vermis (retrocerebellar) 9%.
5. Arachnoid cyst sellar and parasellar 9%.
6. Arachnoid cyst of the interhemispheric fissure 5%.
7. Arachnoid cyst of the convexital surface of the cerebral hemispheres 4%.
8. Arachnoid cyst of the clivus 3%.

Some retrocerebellar arachnoid cysts may mimic Dandy-Walker anomaly, but they do not have agenesis (a term meaning complete absence) of the cerebellar vermis and the cyst does not drain into the fourth ventricle of the brain.

Classification of arachnoid cysts of the Sylvian fissure.

Type 1 arachnoid cyst of the Sylvian fissure, click on the picture to enlarge Type 2 arachnoid cyst of the Sylvian fissure, click on the picture to enlarge Type 3 arachnoid cyst of the Sylvian fissure

Type 1: a small arachnoid cyst in the region of the pole of the temporal lobe, does not cause mass effect, drains into the subarachnoid space.

Type 2: includes the proximal and middle parts of the Sylvian fissure, has an almost rectangular shape, and partially drains into the subarachnoid space.

Type 3: includes the entire Sylvian fissure; with such a cyst, bone protrusion is possible (external protrusion of the scales of the temporal bone), minimal drainage into the subarachnoid space, surgical treatment often does not lead to straightening of the brain (transition to type 2 is possible).

Certain types of congenital arachnoid cysts.

It is worth highlighting separately in this article such congenital cysts as the cyst of the septum pellucidum, the Verge cyst and the cyst of the intermediate velum. There is no point in devoting a separate article to each of the cysts, since you can’t write much about them.

Click on the picture to enlarge CT scan of the brain in the axial plane. The red arrow indicates a septum pellucida cyst. Author Hellerhoff [CC BY-SA 3.0], from Wikimedia Commons, click on the image to enlarge MRI of the brain in the coronal plane. The red arrow indicates a septum pellucida cyst. By Hellerhoff [CC BY-SA 3.0 or GFDL], from Wikimedia Commons

A septum pellucida cyst or septum pellucidum cavity is a slit-like space between the layers of the septum pellucidum, filled with fluid. It is a stage of normal development and does not persist for long after birth, so it is present in almost all premature babies. Found in approximately 10% of adults, it is a congenital asymptomatic developmental anomaly that does not require treatment. Sometimes it can communicate with the cavity of the third ventricle, so it is sometimes called the “fifth ventricle of the brain.” The transparent septum belongs to the midline structures of the brain and is located between the anterior horns of the lateral ventricles.

A Verge's cyst or Verge's cavity is located immediately posterior to the cavity of the septum pellucidum and often communicates with it. Very rare.

The cyst or cavity of the intermediate velum is formed between the thalamus above the third ventricle as a result of separation of the crura of the fornix; in other words, it is located in the midline structures of the brain above the third ventricle. Present in 60% of children under 1 year of age and 30% between 1 and 10 years of age. As a rule, it does not cause any changes in the clinical condition, but a large cyst can lead to obstructive hydrocephalus. In most cases, no treatment is required.

Clinical signs of an arachnoid cyst.

Clinical manifestations of arachnoid cysts usually occur in early childhood. In adults, symptoms appear much less frequently. They depend on the location of the arachnoid cyst. Often cysts are asymptomatic, are an incidental finding during examination and do not require treatment.

Typical clinical manifestations of an arachnoid cyst:

1. General cerebral symptoms due to increased intracranial pressure: headache, nausea, vomiting, drowsiness.
2. Epileptic seizures.
3. Protrusion of the skull bones (this happens rarely, I have never personally encountered it).
4. Focal symptoms: monoparesis (weakness in the arm or leg), hemiparesis (weakness in the arm and leg on one side), sensory disturbances of the mono- and hemitype, speech disorders in the form of sensory (lack of understanding of spoken speech), motor (inability to speak) or mixed (sensory-motor) aphasia, loss of visual fields, paresis of cranial nerves.
5. Sudden deterioration, which may be accompanied by depression of consciousness up to coma:

• Due to hemorrhage into the cyst;
• Due to cyst rupture.

Diagnosis of arachnoid cyst.

Neuroimaging methods are usually sufficient to diagnose an arachnoid cyst. These are computed tomography (CT) and magnetic resonance imaging (MRI).

Additional diagnostic methods are contrast studies of the cerebrospinal fluid pathways, such as cisternography and ventriculography. They are required occasionally, for example, when examining median suprasellar cysts and when affecting the posterior cranial fossa for the purpose of differential diagnosis with Dandy-Walker anomaly.

Examination of the fundus by an ophthalmologist for hypertension syndrome (intracranial hypertension).

Electroencephalography (EEG) in case there was an epileptic seizure, to determine whether it was really caused by a cyst.

Treatment of arachnoid cyst.

As I said above, most congenital arachnoid liquor cysts are asymptomatic and do not require any treatment. Sometimes a neurosurgeon may recommend dynamic monitoring of the size of the cyst; for this, it will be necessary to periodically perform computed tomography or magnetic resonance imaging.

In rare cases, when an arachnoid cyst is accompanied by the symptoms described above and has a mass effect, surgical treatment is resorted to.

In some cases with a sharp deterioration, due to rupture of the arachnoid cyst or hemorrhage into it, urgent surgical treatment is resorted to.

There is no standard size for an arachnoid cyst. Indications for surgery are determined taking into account the location and symptoms of the arachnoid cyst, and not just its size. This can only be determined by a neurosurgeon during an in-person examination.

Absolute indications for surgery:

1. intracranial hypertension syndrome caused by an arachnoid cyst or concomitant hydrocephalus;
2. the appearance and increase of neurological deficit.

Relative indications for surgery:

1. large “asymptomatic arachnoid cysts” that cause deformation of neighboring lobes of the brain;
2. progressive increase in cyst size;
3. deformation of the cerebrospinal fluid tract caused by the cyst, leading to disruption of the cerebrospinal fluid circulation.

Contraindications for surgery:

1. decompensated state of vital functions (unstable hemodynamics, breathing), terminal coma (coma III);
2. the presence of an active inflammatory process.

There are three possible options for surgical treatment of arachnoid cysts. Your treating neurosurgeon chooses the tactics, taking into account the size of the cyst, its location and your wishes. Not all three methods are suitable for all arachnoid cysts.

Evacuation of an arachnoid cyst through a burr hole in the skull using a navigation station. The advantage is simplicity and speed of implementation with minimal trauma to the patient. But there is a drawback - the high rate of cyst recurrence.

Open surgery, that is, craniotomy (cutting out a bone flap on the skull, which is placed in place at the end of the operation) with excision of the walls of the cyst and fenestration (drainage) into the basal cisterns (cerebrospinal fluid spaces at the base of the skull). This method has the advantage of allowing direct examination of the cystic cavity, avoiding a permanent shunt, and is more effective for the treatment of arachnoid cysts consisting of multiple cavities.

Shunt surgery with installation of a shunt from the cyst cavity into the abdominal cavity or superior vena cava near the right atrium through the common facial vein or internal jugular vein. Many foreign and domestic neurosurgeons consider shunting of an arachnoid cerebrospinal fluid cyst to be the best treatment method, but it is not suitable in all cases. The advantage is low mortality and low rates of cyst recurrence. The disadvantage is that the patient becomes dependent on the shunt, which is installed for life. If the shunt becomes blocked, it will have to be replaced.

Complications of the operation.

Early postoperative complications - liquorrhea, marginal necrosis of the skin flap with dehiscence of the surgical wound, meningitis and other infectious complications, hemorrhage into the cyst cavity.

Outcomes of treatment of arachnoid cyst.

Even after successful surgery, part of the cyst may remain, the brain may not fully expand, and displacement of the midline structures of the brain may persist. It is also possible to develop hydrocephalus. As for focal neurological symptoms in the form of paresis and other things, the longer it exists, the less chance of its recovery.

Literature:

1. Neurosurgery / Mark S. Greenberg; lane from English - M.: MEDpress-inform, 2010. - 1008 p.: ill.
2. Practical neurosurgery: A guide for doctors / Ed. B.V. Gaidar. - St. Petersburg: Hippocrates, 2002. - 648 p.
3. Neurosurgery / Ed. HE. Drevalya. - T. 1. - M., 2012. - 592 p. (Guide for doctors). - T. 2. - 2013. - 864 p.
4. Ivakina N.I., Rostotskaya V.I., Ozerova V.I. and others. Classification of intracranial arachnoid cysts in children // Current issues of military medicine. Alma-Ata, 1994. Part 1.
5. Mukhametzhanov X., Ivakina N. I. Congenital intracranial arachnoid cysts in children. Almaty: Gylym, 1995.
6. K.A. Samochernykh, V.A. Khachatryan, A.V. Kim, I.V. Ivanov Features of surgical tactics for large arachnoid cysts. \\ Scientific and practical journal “Creative surgery and oncology” Academy of Sciences of the Republic of Belarus Media Group “Health”, Ufa, 2009
7. Huang Q, Wang D, Guo Y, Zhou X, Wang X, Li X. The diagnosis and neuroendoscopic treatment of noncommunicating intracranial arachnoid cysts. Surg Neurol 2007

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