CSF cyst of the brain (arachnoid cyst) - is a benign neoplasm located between the hard and arachnoid (arachnoid) membranes. At the site of formation, the arachnoid membrane is divided into two sheets and thickens. Cerebral fluid accumulates between these sheets, which leads to the development of a cystic cavity..

Liquor, or arachnoid cyst is located between the arachnoid and hard shells of the brain According to medical statistics, the disease occurs in approximately 4-5% of adults. However, in most cases, cerebrospinal fluid cysts have a small volume and do not manifest themselves clinically, so the data may be inaccurate.. Only with an increase in the size of the neoplasms begin to put pressure on the brain, which causes symptoms of an intracranial (intracranial) space-occupying formation..

Arachnoid cystic formations are most often localized above the Turkish saddle, in the region of the Sylvian sulcus or cerebellopontine angle.

Classification By origin, cystic neoplasms are:.

congenital (primary) - occur even at the stage of intrauterine development;

acquired (secondary) - their causes are pathological processes (bleeding, inflammation, traumatic injuries) occurring in the meninges.

Depending on the characteristics of the morphological structure, cavitary arachnoid formations are divided into two types:.

simple - their cavity is lined with cells that produce cerebral fluid;

complex (retrocerebellar) - their structure includes various tissues (cells of the arachnoid membrane, neuroglia).

According to the features of the clinical course, there are:.

frozen - they are characterized by a latent course, lack of growth;

progressive - accompanied by a gradual increase in neurological symptoms, which is associated with an increase in the size of the formation and compression of brain structures by it.

CausesPrimary neoplasmsCongenital cerebrospinal fluid cysts are associated with anomalies in the structure of the brain, which are formed even at the stage of intrauterine formation of the organ. Factors that can provoke their development include negative effects on the body of a pregnant woman and the developing fetus:.

intoxication (taking drugs with a teratogenic effect, drug addiction, smoking, alcohol abuse, occupational hazards);

infections (cytomegalovirus, herpes, rubella, toxoplasmosis);

overheating (frequent visits to baths, sunbathing);

radiation exposure.

Often, the appearance of arachnoid formations is diagnosed in patients suffering from hypogenesis of the corpus callosum and Marfan's syndrome..

Secondary neoplasms The causes of secondary cerebrospinal fluid cysts are:.

traumatic brain injury (bruises, concussions);

neurosurgical interventions;

meningitis;

meningoencephalitis;

arachnoiditis;

subdural hematoma or subarachnoid hemorrhage.

Stages of the clinical course Clinically, CSF formations begin to manifest themselves only as their size increases.. This is due to the fact that the volume of the cranium is limited. The growing tumor begins to compress the structures of the brain, which leads to an increase in intracranial pressure, the appearance of neurological symptoms. In accordance with this, several stages of the clinical course of the disease are distinguished, which are presented in the table:.

Stage.

Description.

Clinical Compensation.

There are no signs of brain damage, despite the presence of a tumor in the cranial cavity.

Clinical subcompensation.

A person shows the first signs of brain dysfunction.

Partial clinical decompensation.

Characterized by persistent neurological disorders.

Rough clinical decompensation.

There is a dislocation (displacement of structures), wedging into the foramen magnum of the brain. Against this background, the patient begins to show initial signs of a violation of basic vital functions..

Terminal.

Disturbances in the regulation of respiration, cardiovascular activity are growing, which ultimately becomes the cause of death..

Symptoms Clinical manifestations of cerebrospinal fluid cystic formation include cerebral and focal symptoms:.

Group of symptoms.

Description.

Cerebral.

Their development is associated with an increase in intracranial pressure. The patient develops persistent headaches, which are bursting in nature. They are usually worse at night and early in the morning.. At the height of the pain attack, nausea occurs, there may be repeated vomiting. Psychiatric disorders may develop (psychomotor agitation, impaired critical abilities). Examination of the fundus reveals congestion.

Focal.

Caused by local damage to certain brain structures.

When the formation is localized in the region of the frontal lobes, motor function suffers to a greater extent and the patient develops muscle hypertonicity, instability appears when walking, and speech disorders may occur..

Damage to the parietal lobe is characterized by impaired perception and sensitivity.

Signs of damage to the temporal lobe are hallucinations, convulsions, defects in auditory perception.

Localization of the cerebrospinal fluid cyst in the region of the occipital lobes causes a violation of the functions of the visual analyzer. With this form of the disease, the patient has symptoms such as cortical blindness, visual agnosia, visual illusions..

DiagnosisIt is possible to establish the presence of an intracranial mass formation according to the data of a neurological examination and the results of an initial examination, which includes the following methods:.

echoencephalography (Echo-EG);

rheoencephalography (Rheo-EG);

electroencephalography (EEG).

In order to clarify the localization and nature of the volumetric neoplasm, MSCT and MRI of the brain with contrast are shown.. The use of a contrast agent allows for differential diagnosis between a cerebrospinal fluid cyst and another formation, since the contrast can accumulate in the fluid contents of the cystic cavity.

Based on the results of the diagnosis, a decision is made on the need for surgical treatment of a cystic neoplasm. Treatment If the patient is diagnosed with a frozen CSF cyst with clinical compensation, then treatment is not indicated. In this case, the patient should be registered with a neurologist with a mandatory annual MRI..

With a progressive cyst in the stage of clinical subcompensation, the patient is prescribed conservative therapy aimed at lowering intracranial pressure. If it fails, surgery is indicated.. The choice of the method of surgery in each case is carried out by a neurosurgeon, taking into account the characteristics of the disease, the age of the patient, the presence or absence of concomitant pathology.

Currently, the following surgical techniques are most commonly used:.

Complete excision. The indication for surgery is a rupture of the capsule or hemorrhage in the formation cavity.. The intervention is quite traumatic, and the recovery period is long..

Endoscopic Fenestration. A small hole is made in the bones of the skull with a cutter. Through it, puncture and aspiration of the liquid contents of the neoplasm are performed, followed by the creation of holes between its cavity and the subarachnoid space or ventricles of the brain. After that, the cavity in the arachnoid membrane is no longer filled with fluid and therefore the disease does not progress..

cystoperitoneal shunting. The essence of this operation is that a path is created for the outflow of cystic contents into the abdominal cavity, where it is absorbed into the blood.

Prognosis With a frozen cerebrospinal fluid cyst, the prognosis is favorable. Such formations can exist throughout the patient's life without any symptoms.. The danger is progressive neoplasms. With untimely diagnosis and treatment, they can cause persistent neurological deficit, patient disability, and even death..

Prevention Prevention of congenital CSF cysts is based on the prevention of congenital developmental anomalies and includes the following areas:.

exclusion of exposure to a pregnant woman of teratogenic factors;

rational management of pregnancy;

gentle delivery.

Prevention of acquired CSF cysts is based on the timely and complete treatment of vascular and inflammatory cerebral diseases, traumatic brain injuries..

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