NEUROLOGICAL CYSTS

 

What are Neurological cysts?

The term Neurological cysts refers to fluid-filled sacs found in the nervous system. These cysts commonly occur in the brain and occasionally, in the spinal cord. 

Whether cancerous or benign, they may contain cerebrospinal fluid (CSF), blood, pus or other materials such as hair follicle cells or sweat gland cells. 

What are the types of brain cysts?

ARACHNOID CYST 

Arachnoid cysts refer to cerebrospinal fluid-filled sacs that occur as a result of invagination (infolding) of the arachnoid membrane. The arachnoid membrane forms one of the three layers of the covering of the brain and spinal cord.

Arachnoid cysts occur both in the brain (intracranial arachnoid cysts) and in the spinal cord (spinal arachnoid cysts).

As the most common type of brain cyst, arachnoid cysts affect both children and adults but with increased occurrence among males.

An Arachnoid cyst may show no symptoms and only come to light incidentally when a patient receives a brain scan for other reasons. 

Arachnoid cysts may develop in-utero (Society for Maternal-Fetal Medicine (SMFM), 2020) or form following a traumatic head injury (secondary arachnoid cyst).

COLLOID CYST

Colloid cysts occur rarely and mostly only in adults. Similar to arachnoid cyst, colloid cysts develop in-utero and increase in size over time. Colloid cyst usually develop in the ventricles of the brain, particularly the third ventricles (Tenny, Thorell, 2021). The location of this cyst in the ventricles poses a risk of hydrocephalus if the cyst obstructs the flow of cerebrospinal fluid. Hydrocephalus refers to a medical condition that results from accumulation of fluids in the ventricles of the brain.

DERMOID CYST 

Dermoid cyst refers to a rare type of cyst that can contain skin cells, sweat glands, or even hair follicles. (Tolebeyan, Kuruvilla, 2020) Dermoid cysts usually form during fetal development when skin and accessory skin structures get trapped inside the body. Apart from the brain, these cysts can occur in other parts of the body such as the ovaries, testicles, neck, face, spine etc. Dermoid cysts often appear during childhood. 

EPIDERMOID CYST 

Epidermoid cysts, similar to dermoid cysts, form when a bit of tissue gets trapped between other tissues during the development of the brain and spinal cord. Epidermoids however, have only squamous epithelium and do not contain sweat glands or hair follicle cells. Epidermoid cysts grow very slowly, so patients often only discover them in adulthood.

PINEAL CYSTS

A Pineal cyst refers to cysts found within the pineal gland. They occur commonly but usually show no symptoms and only appear when the brain gets scanned for a different reason. Sometimes radiologists conduct an MRI with the aid of an intravenous contrast (dye) to rule out a pineal tumor.

BRAIN ABSCESS

A brain abscess refers to a cystic accumulation of pus in the brain. These abscesses usually occur following infection of the brain tissue. Infections get to the brain through direct spread from infections in the ears, teeth, sinuses or after a severe head injury. Infections can also spread from more distant parts of the body (the lungs for example) via the blood to the brain. In a few cases, the source of the infection remains unknown.

What are the symptoms of Neurological Cysts? 

In most cases, people with neurological cysts do not come down with symptoms. In symptomatic cases, symptoms depend on the size and location of the cyst. Small cysts usually show no symptoms while large cysts can cause symptoms related to their location in the nervous system. Some small asymptomatic cysts can eventually grow large and symptomatic (Ahlhelm et al., 2018). Large cysts can cause an increase in the intracranial pressure by blocking the flow of cerebrospinal fluid or by their sheer volume.

Patients can present with symptoms early in life or in adulthood.

Common symptoms of neurological cyst include;

  • Headaches
  • Nausea and vomiting
  • Fever (Brain abscess)
  • Seizures (less common)
  • Macrocephaly (especially in newborns and infants)
  • Developmental delay
  • Visual or hearing impairments
  • Vertigo or dizziness
  • Difficulties with balance and walking
  • Behavioral changes
  • Hemiparesis

How Do Fort Worth Neurosurgeons Diagnose Neurological Cysts?

The process of diagnosing a cyst involves taking a detailed medical history, physical exam and laboratory testing.  

The primary care physician provider will ask questions about the patient’s symptoms, past medical conditions and family’s medical history. After ruling out other causes of the symptoms the primary care physician will refer them to a neurosurgeon (a surgeon who performs brain or spinal cord surgery).

 The neurosurgeon carries out more specific investigations using imaging studies such as;

  1. MRI (Magnetic Resonance Imaging) 
  2. CT (Computerized Tomography) scans

Later, neurosurgeons can perform more extensive testing based on the specific type of the cyst. In brain abscesses, CT-guided aspiration aids the collection of pus samples for testing. 

How Do Fort Worth Neurosurgeons Treat Neurological Cysts?

Fort Worth Neurosurgeons would come up with a treatment plan based on the type, size and location of the cyst. 

Small asymptomatic cysts only require active surveillance. 

Abscesses require treatment with antimicrobials and surgery to drain the cyst.

If a cyst gets complicated by hydrocephalous, the neurosurgeon carries out a surgical procedure to insert a tube (shunt) in the brain to drain CSF and relieve pressure on the brain. Shunting refers to the medical term for the placement of a tube inside a cyst to allow draining into another part of the body (usually the abdomen) where absorption takes place.

Most times neurosurgeons do a complete excision of the cyst to prevent reoccurrence. Our surgeons explore surgical options such as craniotomy and endoscopic surgery (Cherian, (2017). In these cases, Endoscopic surgery surpasses craniotomy owing to the low invasiveness of endoscopic procedures and the resultant reduction in complications. For more questions or information, please contact us.

References.

  1. Tenny, S., & Thorell, W. (2021). Colloid Brain Cyst. In StatPearls. StatPearls Publishing.
  2. Tolebeyan, A. S., & Kuruvilla, D. E. (2020). Headache in Ruptured Intracranial Dermoid Cysts. Current pain and headache reports, 24(7), 31. https://doi.org/10.1007/s11916-020-00863-x
  3. Society for Maternal-Fetal Medicine (SMFM), Yeaton-Massey, A., & Monteagudo, A. (2020). Intracranial Cysts. American journal of obstetrics and gynecology, 223(6), B42–B46. https://doi.org/10.1016/j.ajog.2020.08.185 
  4. Cherian I. (2017). Role of neuro-endoscopy and fenestration in the management of brain cysts. Neurology India, 65(3), 473–474. https://doi.org/10.4103/neuroindia.NI_319_17 
  5. Ahlhelm, F., Shariat, K., Götschi, S., & Ulmer, S. (2018). Intrakranielle zystische Läsionen [Intracranial cystic lesions]. Der Radiologe, 58(2), 120–131. https://doi.org/10.1007/s00117-017-0322-z

ABOUT LONGHORN BRAIN & SPINE

Founded on Excellence

Founded by Neurosurgeon, Dr. Grant Booher, Longhorn Brain and Spine focuses on a patient-centered approach to alleviating North Texans from Neurological and Spinal Pain.  Dr. Booher and his clinical team believe in exhausting all non-invasive protocols first and if needed, employing the least invasive procedures necessary to treat the patients.

Our Beliefs

Dr. Booher believes in a conservative, individualized and holistic approach when it comes to his patients. He prefers exhausting all nonsurgical options and proudly offers the least invasive techniques when clinically indicated. He strives to treat every patient like a member of his family. During his free time, he and his wife enjoy watching sports, listening to Texas country music, and traveling.