Subependymal cyst refers to benign brain tumors and develops from ependyma (tissue lining the ventricles of the brain from the inside).

In the vast majority of cases, a subependymal cyst of the brain does not affect the health of the child. Characteristics It is necessary to differentiate two concepts: pseudocysts and true cystic formations, as reported by the online publication for girls and women from 14 to 35 years old Pannochka. net View.

Characteristic.

Pseudocysts.

More like intrauterine malformations. They do not have an epithelial lining. Localized under the ependyma of the lateral ventricles of the cerebral hemispheres in the region of the lateral angles of the anterior horns and bodies of the lateral ventricles, as well as in the border region between the head of the caudate nucleus and the thalamus.

True (arachnoid, retrocerebellar, cerebrospinal fluid).

have an epithelial lining. As a rule, their appearance is associated with hemorrhages, trauma and other external causes..

For this reason, a subependymal cyst in a newborn child would be more correctly called a pseudocyst..

Features of the pathology:.

The cavity is filled with serous fluid without signs of infection.. No signs of hemorrhage.

More often occurs in the tissues of the ependyma of one ventricle, less often in two.

The wall is formed by a layer of glial cells (the structure is thin-walled because there is no inner lining).

It does not tend to grow, because it fills with liquid very slowly.

It has a rounded shape, small size and clear and even contours..

Infants with such a pathology require dispensary registration with a neurologist (periodic monitoring of ultrasound, MRI / CT). No treatment required.

The pathogenesis is based on intrauterine disruption of the normal development of ependyma in the fetus (cell hyperplasia, slowing down their differentiation). Various external influences lead to disruption of the normal cerebral circulation in the fetus, which leads to hypoxia / ischemia and necrosis of ependymal areas. This serves as a predisposing factor in the development of a pseudocyst..

Education may be:.

endophytic location - in the wall of the ventricles of the brain at the site of an underdeveloped ependyma;

exophytic location - over the ependyma with prolapse directly into the lumen of the ventricles.

Symptoms This type of neoplasm does not cause significant cerebral impairment and, as a result, the manifestation of symptoms (asymptomatic carriage). More often detected as an accidental finding in the diagnosis of pregnant women (planned ultrasound).

If, nevertheless, symptoms occur, it depends on the form, general condition (full-term / premature baby), concomitant diseases (malformations of organs and systems).

TreatmentSubependymal cyst of the brain in a newborn with a small size is not subject to treatment and does not affect the life and development of the child.

Indications for surgical treatment An operation to remove a cyst is required in the following cases:.

fast growth;

serious violations of the outflow of cerebrospinal fluid (development of hydrocephalus);

suspicion of a malignant tumor (in this case, we are not talking about the degeneration of the subependymal cyst, but about the presence of other formations that were not correctly interpreted);

significant increase in intracranial pressure;

convulsive syndrome, which is not stopped by medication;

hemorrhage is suspected.

Typical signs of hydrocephalus:.

increase in head volume in a short period of time;

pulsation and bulging of fontanelles;

divergence of the bones of the skull, which leads to a visible deformity of the head;

lag in psychological development as a consequence of ischemia of brain tissues under constant fluid pressure.

Preparation for surgeryPreparation for surgery includes the following studies:.

general analysis of blood and urine;

coagulogram;

blood chemistry;

determination of blood group and Rh factor;

ultrasound;

CT/MRI.

Methods of surgical interventionView.

Operation steps.

Ventriculo-peritoneal shunting.

Used for symptoms of hydrocephalus. The essence of the operation is to create a kind of system between the ventricles of the brain and the abdominal cavity in order to divert excess CSF. This is achieved using special silicone catheters.. When placing a shunt, as a rule, neurosurgeons and pediatric surgeons work at the same time. Stages:.

The operation is performed in the area of \u200b\u200bthe temporal bones (right or left at the Kocher point). The tissues are dissected in layers, then the bones of the skull are separated (not completely, leaving a nutritional leg on one side of the wound). The ventricular system is punctured using a ventricular catheter.

At the same time, pediatric surgeons enter the abdominal cavity using laparoscopic techniques (access to the peritoneum). Further, with the help of a shunt-passer (special conductor) in the subcutaneous fatty tissue, a stroke is made up to the burr hole (passes through the subcutaneous tissue of the abdominal wall, chest wall, neck and part of the skull).

Two systems connect at the burr hole: the distal part of the catheter, which extends from the peritoneum, and the ventral part of the catheter, which exits the ventricles of the brain.

The system is checked for consistency (no CSF \u200b\u200bleakage, twists or bends).

The fabrics are tightly sutured in layers.

Requires periodic monitoring of the state of the shunt.

Endoscopic intervention (ventricular endoscopy).

Carried out using special high-tech equipment. This technique is optimal for cystic formations, the complete excision of which is impossible due to the deep location.. With the help of an endoscope, surgeons obtain a visual picture of the internal cavity of the brain ventricles.. This allows you to determine the exact localization of the cyst and the nature of hydrocephalus (occlusive). The surgeon makes a hole in the skull bone, through which an endoscope will be inserted, with which the cyst wall is incised. Thus, its cavity is connected to the cerebrospinal fluid system (a special variant of drainage of the formation).

The most commonly performed endoscopic ventriculocisternostomy of the fundus of the third ventricle. In this case, all the fluid from the third ventricle is excreted into the cisterns of the brain..

trepanation of the skull.

The most traumatic type of surgery. It is extremely rarely used for this type of pathology, since this method is more suitable for superficial formations.. Stages:.

The tissues of the skin and subcutaneous adipose tissue, aponeurosis up to the bones of the skull are dissected in layers.

Holes are made in the bone using a special tool..

The bones between the holes are filed and separated, exposing the part of the brain covered with membranes..

The membranes are carefully incised and gradually go deep into the cyst until a cyst is found..

Complete or partial excision of the cavity is performed with sending the biomaterial for cytological or histological examination.

The wound is sutured in layers, and the skull bones are fixed with titanium plates..

Postoperative drug therapyThe course of drugs in the postoperative period includes:.

Anticoagulants to prevent thrombosis. These include Heparin, Antithrombin.

Immunomodulators to support the immune system as it is deficient in newborns. The drugs of the group include cytokines, Interferon.

Antibacterial or antiviral agents to prevent infection - Cefepime, Azithromycin.

Nootropics to restore brain function - Nootropil.

Antioxidants and vitamin complexes to restore metabolic processes in tissues.

If necessary, the postoperative period includes infusion-detoxification therapy (physiological solutions, Ringer's solution, glucose).

Neurosonography, or ultrasound of the brain, is the main method for diagnosing brain cysts in children. Possible consequences. Consequences occur in the event of complications (rupture, suppuration, hydrocephalus) or after surgery:.

Lag in mental and physical development (speech delay, memory impairment). It does not occur immediately, but as the child grows by 2-3 years. This complication is caused by prolonged compression of the brain tissue and irreversible changes in the cerebral cortex.. Manifested to varying degrees (with mild disturbances will not interfere with normal life).

epileptic seizures. Arise as a result of reflex trauma to brain tissue (violation of nerve conduction in a separate part of the brain). Status epilepticus is rare.

Bleeding with the formation of hematomas in the cavity of the ventricles or in the substance of the brain. A formidable complication, which in some cases requires a second operation and removal. Total hemorrhage (stroke) rarely occurs in children.

cerebral edema. Occurs when the aqueduct of the brain is damaged. In this case, the liquor-carrying ducts can become blocked, and hydrocephalus occurs, but already as a secondary phenomenon.. The complication requires immediate treatment, since if the medulla oblongata is damaged, respiratory or cardiac arrest may occur..

Accession of infection with the occurrence of abscesses, encephalitis or meningitis.

In this case, a mandatory course of antibiotics is indicated in the postoperative period..

Focal symptoms (loss of visual fields, hearing loss, loss of sensation). Manifestations will depend on the specific area that was traumatized during surgery..

Complications are relatively rare.

Prognosis Both pediatricians (for example, the famous Dr. Komarovsky) and neurologists give a favorable prognosis in 90-95% of children with this pathology.

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