Brain cyst treatment
A brain cyst is a benign cavity formation often filled with liquid. Unlike malignant tumours, brain cysts do not usually require urgent treatment or are easily removed during surgery. However, the cyst might compress the neighbouring brain tissue. Such procedures include drainage, shunting, fenestration, and endoscopic surgery.
A brain cyst is a cavity in the brain filled with fluid. The cyst is quite common: people of all ages are prone to it. Despite the benign nature of the formation, it can cause a lot of trouble, primarily related to the compression of some brain areas.
There are two main mechanisms of cyst formation:
- Congenital cysts - arise because of embryogenesis disorders in the intrauterine period of the foetus (for example, a cyst of the pineal region of the brain.
- Dermoid - formed during prenatal development, their structure is heterogeneous, includes elements of fatty nature, fragments of ectoderm (hair, skin scales, teeth);
- A colloid cyst is a benign, slow-growing neoplasm that contains a colloid (gelatinous) fluid encapsulated by connective tissue cells. They are formed so that blocking the flow of circulating fluid leads to the development of hydrocephalus.
- Acquired - arises due to a violation of the physiological outflow of biological fluids with their subsequent accumulation in the pathological cavities that have formed.
The location of cysts in the head of an adult varies: they can be located intracerebral (cerebral cyst - in the hemispheres of the brain, pineal gland, pituitary gland) and extracerebral (arachnoid cyst).
- A pineal gland cyst is a benign formation lined inside with collagen fibres, glial cells and cells of a normal gland. The cyst is formed in the pineal gland's location, that is, in the middle of the two main hemispheres of the brain.
- An arachnoid cyst is a cerebrospinal fluid cyst, the walls of which are formed by cells of the arachnoid membrane. It is a bubble of fluid accumulated between the glued layers of the meninges. In more rare cases, it can also form in the spinal cord.
- The term porencephalic cyst is localised in any area of the brain substance at the site of dead tissue. This dangerous type of cyst is fraught with the development of such diseases as hydrocephalus and several other complications.
What causes a brain cyst? How to recognise its symptoms, and who is most prone to its formation? How is a cyst treated? This writing is devoted to all these questions.
What is the cause of brain cyst formation?
After a traumatic injury, part of the brain tissue loses its structure. A zone of cystic transformation frequently replaces it. In addition, adjacent areas of subarachnoid spaces are locally expanded due to cortical atrophy (simulating arachnoid).
Post-ischemic changes are visualised similar to post-traumatic changes but differ in localisation. As a result, new tissue areas affected by a stroke (ischemic or hemorrhagic) form. The situation is exacerbated by impaired blood circulation.
Many brain cysts can occur after brain surgery - postoperative genesis. For example, suppose the operation's goal is to remove a tissue fragment. In that case, a local expansion of spaces similar to arachnoid spaces will occur. In addition, a progressive, uncontrolled inflammatory process in the brain is also a provoking factor for the formation of cysts. Finally, parasites can harm the brain, forming a membrane around the foreign body.
Brain cysts are also can be congenital. During pregnancy, their appearance can be provoked by unfavourable factors. Most often, they include hypoxia of the baby, fetoplacental insufficiency, TORCH infections and extragenital diseases of the pregnant woman.
Signs of brain cyst
Initial neurological manifestations usually occur when a cyst exerts compressive pressure on the surrounding tissues or crosses the cerebrospinal fluid pathway. Otherwise, cysts will be unexpected findings that do not cause inconvenience.
Although a cyst of the brain is benign, it threatens the patient's life because it squeezes the surrounding tissues. In addition, it violates the functions of the limbs, the work of the gastrointestinal tract, and the organs of the genitourinary system (organs related to the affected brain parts).
Symptoms always depend on the location of the cyst and its size. The main signs are:
- Dizziness and headache;
- Nausea and vomiting;
- Increased intracranial pressure;
- Deterioration of sleep quality;
- Impaired vision, hearing, speech;
- Change of coordination;
- Memory impairment;
- Unexplained mood swings.
The signs may also manifest as convulsions, paralysis, endocrine disorders or hydrocephalus. But these symptoms occur more seldom and mainly in children.
So, the symptomatic picture is determined by the localisation, as well as by the part of the brain that is under pressure. It is because each area in the brain is responsible for a certain number of functions in the body.
- For example, a cerebellum compressed by a cyst deteriorates the work of the vestibular apparatus: a person is prone to loss of balance and dizziness.
- If the pressure is on the hypothalamus, the metabolism is disturbed: the feeling of satiety, hunger, and thirst may disappear.
- If the thalamus is crushed, numbness, deafness, blindness, and loss of taste sensations are possible (since it is responsible for receiving information).
The same happens with other brain areas under the pressure of the brain cyst: their work stops partially or even completely. Large cysts can cause severe problems in the body's work, up to a vegetative state, paralysis, and dementia.
Who neurosurgeons diagnose a cyst in the brain?
The formation requires a qualitative approach to diagnosis. If the cyst is located superficially (rare cases), the doctor can see it during examination and palpation. In other instances, imaging methods are used to verify the size, its relationship with adjacent tissues, and the presence of possible complications:
- Neurosonography (ultrasound through the large parietal bone) — the examination is performed on children in the first year of life (sometimes up to 26 months) until the parietal bone becomes rigid.
- MRI (magnetic resonance imaging) with contrast is the most accurate method for studying the location, size, and presence of compression caused by a cyst in the brain of surrounding nerve structures.
- CT (computed tomography) is a quick and informative test. Still, MRI is preferred because of the radiation exposure and better visualization during MRI for soft tissues.
- Electroencephalography is effective as a differential diagnosis of epilepsy caused by cystic formation and epilepsy of other etiologies.
- Puncture - taking biological material by inserting a needle into the cavity. It is necessary to determine the content of the cyst.
- Cerebrospinal fluid examination – may help detect intracerebral haemorrhage (bleeding in the brain) and measure cerebrospinal fluid pressure.
Treatment of a cyst in the brain
The treatment is prescribed depending on the cyst type and location. For example, a non-dynamic cyst of a small size does not require any treatment and does not affect the functioning of the brain but requires constant medical monitoring.
Doctors can try to remove medium-sized cysts with medication. For this, physicians treat the disease that contributed to the cyst formation. For example, suppose narrowing of blood vessels is a cause. In that case, vasodilators, antispasmodics and drugs for lowering the level of cholesterol are prescribed. If the reason were hypertension, it would be treated, and so on.
Large cysts require urgent surgical intervention because they complicate the brain's work, damage tissues, and disrupt mental function and the entire body. The following neurosurgical methods carry out operations:
- Endoscopic uses microsurgical instruments and a special tube with micro-optics. The equipment allows neurosurgeons to penetrate deep into the tissues to remove the cyst.
- Drainage ensures the outflow of fluid from the cyst. The surgeon inserts a thin, soft tube through a small hole made in the skull. It is connected to a sterile system, and the accumulated cystic fluid is discharged into an external reservoir.
- Shunting ensures normal circulation of cerebrospinal fluid. A careful puncture is made in the bones of the skull, through which a drainage tube is inserted into the cyst. The contents of the cyst are pumped out.
- Fenestration involves making an incision in the skull to access the cyst. It allows the fluid to drain and be absorbed by the surrounding tissues, thereby reducing the pressure it puts on the brain. Although it is more invasive than the previous methods, it is more effective and definitive.
- Endoscopic fenestration is an improved technique with the same advantages as fenestration but is less invasive. The trepanation of the skull is not needed. This procedure uses an endoscope (a special tube with a camera on the tip) to drain fluid from the cyst. This technique is considered the most modern for brain cyst treatment.
The patient should talk to the doctor to understand which procedure is most suitable for a particular type of cyst. In addition to factors such as the location or size of the cyst, neurosurgeons also consider the age and general condition of the patient.
Neurological rehabilitation after surgery is an important stage to restore lost brain functions and prevent possible complications. The rehabilitation includes massage, speech therapy, psychotherapy, vitamins, and physiotherapy. The duration of the rehabilitation period depends on many factors. These are the size and localization of cysts, the severity of the process and condition, the age, and the degree of loss of brain functions. However, as a rule, the duration of rehabilitation varies from several weeks to several months.
Brain cyst prognosis
The different prognosis for a cyst in the brain largely depends on the size. If the formation rapidly increases and this problem is noticed and treated in time, the forecast will be favourable. However, with the development of severe neurological disorders, it might be impossible to restore brain functions. A particular danger is the rupture of the cyst, which leads to the patient's death.
In the absence of timely treatment and the growth of cystic cavities, severe disorders will occur, leading to loss of hearing and vision, impaired motor function, and mental disorders.
What is the best surgical technique for brain cyst treatment?
Endoscopic surgery is the safest and non-traumatic method of cyst removal. It is carried out by inserting an endoscope with a video camera into a puncture in the skull. The cyst's contents are removed, and its walls fall and dissolve.
Which doctor should I contact for a cyst in the brain?
A neurosurgeon is a leading specialist in treating brain cysts. He deals with verification, considers all the indications and chooses the most optimal option for surgery or therapy. Nevertheless, when the first symptoms appear, patients visit neurologists. They play an essential role in differential diagnosis and further referral to the right specialist (neurosurgeon, oncologist, endocrinologist).
Can I treat a brain cyst without surgery?
Most cysts do not require any surgical intervention. Often, they are not large, do not press on the surrounding tissues, and do not cause any complications. Therefore, neurosurgeons do not operate on this type of cystic formation and can use medical treatment. But such cases require regular and careful monitoring with periodic MRI control.
Is brain cyst dangerous?
Only a cyst that has 10 mm and managed to stretch tens of mm in length can be classified as dangerous. With rapid growth, the cyst in the brain can increase several times in a couple of months. Large cysts lead to intracranial compression and displacement of the brain stem (dislocation syndrome). Moreover, it damages the centres of respiration and cardiovascular activity, finally leading to death.
Why do patients go abroad for brain cyst surgery?
From a professional point of view, neurosurgery is one of the most challenging areas in medicine. It requires a lot of knowledge, years of experience and control over the mind and body. Therefore, leading experts work mainly in countries such as the USA, Israel and Germany. In addition, the advantages of foreign clinics are minimally invasive treatment methods: most sparing for health and bringing the least harm to the patient.
Where can I get Brain cyst treatment?
What are the best clinics for Brain cyst treatment?
Who are the best doctors for Brain cyst?
Prof. Dr. med. Bernhard Meyer from University Hospital rechts der Isar Munich
Dr. med. Peter Madjurov from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Thomas Gasser from Beta Clinic Bonn
Prof. Dr. med. Marcus Czabanka from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Jorg-Christian Tonn from University Hospital Ludwig-Maximilians Munich