Brain Cyst

A brain cyst, also known as the cystic brain lesion, refers to the fluid-filled sac within the brain. The cyst can either be cancerous (malignant) or noncancerous (benign). Malignant cysts develop and can metastasize to other body parts with time while benign doesn’t spread. Furthermore, a cyst can consist of pus, blood, and other content. But in the brain, it can sometimes include cerebrospinal fluid (CSF), a liquid responsible for cushioning and bathing the brain and spine. 

Brain cyst may not necessarily be cancerous; however, it can still result in a number of health issues. The cyst can put too much pressure on the brain tissue, causing various symptoms, including headache and vision problems. Early diagnosis and treatment are thus essential to prevent more complications. 

Types of Brain Cysts 

There are several types of brain cysts that can develop and affect both children and adults. Some cysts start before birth, while others grow over time due to certain underlying causes. They include the following; 

• Arachnoid cyst 

This type of brain cyst is also referred to as leptomeningeal cyst. It's a cyst that develops between the arachnoid membrane and the brain. Arachnoid membrane refers to one of the defensive coverings of the brain. CSF contains an arachnoid cyst. They are most common among minors but can also occur in adults. Furthermore, this form of cyst occurs more frequently in males, unlike females.

• Colloid cyst

This is a gel-filled cyst that usually develops in one of the four ventricles within the brain. While these ventricles are the cerebrospinal fluid reservoir within the brain, a colloid cyst mostly occurs in the third ventricle. The third ventricle is located in the central part of the brain. Therefore, the growth of a cyst in this area can result in CFS flow on and off blockage and lead to position headaches. Positional headaches are a type of headache that occurs whenever a person stays in a particular position. 

• Dermoid cyst

Although rare, the dermoid cyst can sometimes occur. It develops when some skin cells are trapped if the spinal cord and the brain form prior to birth. The dermoid cyst can comprise hair follicle cells or sweat gland cells. They are more common among children than adults. 

• Epidermoid cyst 

This is also referred to as an epidermoid tumor. As with a dermoid tumor, the epidermoid tumor develops from tissue that remains trapped as the spine and brain form. However, these cysts don’t contain hair follicle cells or sweat glands. Furthermore, they grow gradually and usually appear during adulthood. 

• Pineal cyst

This occurs on the pineal gland located in the central part of the brain. In most cases, the pineal cyst is detected during an imaging scan performed for various reasons other than diagnosing the cyst. Although they rarely cause any severe problems, they can impair the vision if they develop largely. Moreover, they can affect individuals at any age. 

• Neoplastic cyst

Neoplastic cysts occur as a result of malignant or benign tumors. If the brain tumor begins outside the brain, then it’s referred to as metastatic. An underlying tumour associated with a cyst is usually noticeable because a CT scan or an MRI shows a nodule or lump next to the cyst.

• Brain metastases 

Differentiation of cerebral metastases from brain cysts.

1. lung cancer (48%),
2. breast cancer (15%),
3. melanoma (9%),
4. colon cancer (5%),
5. kidney cancer (4%).

• Brain abscess 

This can develop in any part of the brain as one or multiple cysts. The primary cause of brain abscess is bacterial infections. However, fungus and parasites can sometimes trigger the condition. 

Causes of Brain Cysts

Brain cysts often develop due to fluid buildup in a certain part of the brain. It can occur within the first few days or weeks as the fetus grows in the womb. Moreover, they are common and can affect any part of the brain and sometimes spread to other body parts. 

Brain cysts usually arise due to clogged or obstructed sebaceous glands infection and piercing. Other potential triggers or causes of brain cyst include; 

• A deficiency within the cells 
• Genetic disorders 
• Tumors 
• A defect within the organ of a growing embryo 
• Severe inflammatory diseases 
• Parasites 
• Blockage of the ducts within the body that makes the fluid accumulate 
• A chronic injury or trauma that breaks or damages the vessel 

Usually, the brain cyst doesn’t cause any pain. However, you might experience mild to chronic pain if they rupture, get inflamed, or are infected. 

Cyst vs. Tumor

While some cysts can have associations with tumors and cancer, most cysts are benign. Sometimes, as brain tumors and cancers grow, they can cause a cyst to form

Brain Cyst symptoms

Brain cysts' symptoms and signs can vary depending on the area of the brain in which the cyst is developing. In certain situations, a small minor cyst might not result in any symptoms. On the other hand, other cysts are silent and don't cause any symptoms till they develop into larger cysts. 

In other cases, a person with a condition can experience issues associated with the brain part where the brain cyst is growing. The symptoms can also be a result of blockage of the CSF flow. This could lead to intracranial pressure (increased pressure within the brain). 

In general, the common signs and symptoms that are likely to occur include; 

• Headache 
• Dizziness or vertigo 
• Vomiting and nausea
• Vision or hearing problems 
• Problem walking or balancing well 
• Pain in the face 
• Seizures (rare)

If your child’s pediatrician detects a brain cyst, your pediatrician will refer you to a pediatric neurosurgeon for evaluation, diagnosis, and treatment.

Diagnosing Brain Cyst 

The medical provider can sometimes discover a brain cyst as it appears when performing an imaging scan for some other reason. Among other cases, you might be experiencing cyst-related symptoms. In such situations, the primary care physician can ask you to see a neurologist. A neurologist is a healthcare specialist that specializes in the diagnosis and treatment of central nervous system disorders. Alternatively, you might be sent to a neurosurgeon.

The diagnosis procedure of a cyst usually begins with a physical exam and medical history assessment. The medical provider will inquire about the current symptoms as well as any previous medical issues. Evaluation of the family medical history is also essential. It helps determine if the condition is genetic or there are increased chances of developing the disease and advancing. 

The physical examination can sometimes involve a nervous system test. This entails performing various imaging scans to examine the brain. To help display more clarity in the pictures, the contrast dye can be used. These imaging tests can include the following;  

• Computed tomography (CT) scan

This is an imaging procedure that utilizes x-ray images and computer technology to create detailed pictures of the body. Medical providers can perform scans on the spinal cord and brain to identify underlying cysts. 

• Magnetic resonance imaging (MRI)

This method involves the use of strong magnetic fields and computer technology to generate detailed pictures of the body. The MRI scans of the brain and spinal cord can be performed to acquire more details regarding the cyst and surrounding tissues.

• Encephalography 

The technique for injecting air has become more or less standardized, although roentgenologic procedures continue to differ. To standardize the process and allow for consistent interpretation, Pancoast, Fay, and Pendergrass suggested a roentgenologic method for encephalography.

However, for a fairly unique technique, no one approach should be regarded as standard until different methods have been extensively studied. In pursuit of this notion, we devised at the University of California Hospital a method that differs from that supported as standard by the aforementioned writers. Because it has been shown to be extremely satisfying, it is thought to add to the knowledge gained via encephalography. 

Many of the shadows detected in encephalograms have not been adequately explained. Some of them are attempted to be explained by combining observations made on patients with experimental investigations done on postmortem material.

If necessary, these scans can be replicated after some time to determine if the cyst is developing or advancing.

Brain Cyst Treatment 

Brain cyst treatment usually depends on the type, severity, size, and location in the brain. In case the brain cyst is associated with certain problems, the doctor can recommend surgery to remove it. 

On the other hand, the cyst might not be associated with any symptoms and is not advancing. Therefore, the medical provider may decide to keep a close eye on it through constant brain scans. Generally, treatment varies based on the form of the cyst. 

Pediatric neurosurgeons utilize a minimally invasive method to access the cyst with an endoscope or microscope and then open it to remove the interior fluid during fenestration surgery. This method may be used to avoid the use of a shunt or implanted devices.

A shunt may be inserted into the brain cyst in some situations to drain the fluid away from the brain. If the cyst re-fills with fluid following fenestration, this is generally done. Consult with your pediatric neurosurgeon to determine the best treatment choice for your kid.

The treatment options can thus include the following; 

• Arachnoid cyst

The medical provider can pierce the cyst sac to drain the accumulated fluid if you have an arachnoid cyst. The fluid is either drained into the CSF or is extracted using a needle or catheter. If your doctor drains the cyst without necessarily removing the sac or installing a permanent drainage mechanism, the sac can re-fill with fluid over time. 

Brain cyst surgery

Most brain cysts are benign and do not need surgical excision. If surgery is required, the cyst will be either drained or removed. Many brain cysts are hereditary, but they can also be symptoms of an underlying disease, such as cancer or an infection.

Craniotomy

A craniotomy (surgically making an incision in the skull) may be recommended by your child's surgeon to produce openings in the cyst wall (a technique known as fenestration) and maintain proper flow of cerebrospinal fluid.

This is a more intrusive surgery, but it allows the neurosurgeon to view and treat the cyst directly. Occasionally, the cyst will refill with fluid and will need to be treated again. 

Shunt

Another alternative is to have an arachnoid cyst shunted. The surgeon puts a catheter into the cyst, which allows the fluid to drain and be absorbed elsewhere in the body.

However, your child may develop reliant on the shunt to keep symptoms at bay, and living with a shunt can lead to problems such as obstruction or infection.

• Dermoid and epidermoid cyst 

For people who have an epidermoid or dermoid cyst, the doctor will most certainly extract it. The entire cyst, including the sac, will be taken out. If the cyst is not completely healed, it can reappear and trigger symptoms after some time. 

• Colloid cyst 

Colloid cysts usually result in the accumulation of too much CSF (hydrocephalus). It can result in a serious rise in brain pressure. A drainage or shunt tube may help alleviate some of the brain pressure. However, colloid cysts are sometimes difficult to extract since they are often found deep inside the brain. The medical provider can use specialized surgical tools linked to a tiny endoscopic instrument to remove these cysts.

• Pineal cysts 

Pineal cysts do not often cause any complications. This is generally manageable by keeping an eye out for any shifts in the brain. 

• Tumor cysts 

Tumor cysts may be addressed surgically or through radiotherapy and chemotherapy. The doctor can perform these separately or combine them. 

The treatment for tumor-associated cysts is determined on whether the tumor is of low or high grade. Treatment of the tumor also includes treatment of the cysts that are linked with it.

1. Low-grade tumors associated with cysts are usually treated with surgery.
2. Surgery, followed by radiation treatment with or without chemotherapy, may be used to treat high-grade tumors associated with cysts.

• Brain abscess 

For abscess, the doctor can recommend antibiotics, antiparasite, or antifungal drugs. Sometimes, a brain cyst surgery may be necessary. 

Brain cyst surgery recovery time

Brain cyst healing will be a highly personal process, and your doctor will be able to offer you a personalized sense of what to expect after surgery. However, having a general knowledge of the brain cyst recovery time can give you a good sense of how long your recovery will take.

You will be placed in a dedicated post-anesthesia care facility immediately following your treatment. During this time, your care team will keep an eye on your vital indicators, such as heart rate, respiration, and blood pressure. They will also keep an eye out for any symptoms of problems after your surgery. You will be transferred to your recovery room after you have stabilized.

When to call your healthcare provider?

Call your healthcare provider right away if you have any of these:

• Back and leg pain
• Hearing or vision problems
• Nausea and vomiting
• Trouble with balance and walking
• Numbness and tingling in arms or legs
• Vertigo or dizziness
• Confusion or trouble staying awake

Conclusion 

A brain cyst is a fluid-filled sac that forms in any part of the brain and usually contains cerebrospinal fluid. The cysts can vary in type, size, and location within the brain. While some cysts are malignant and chronic, others are benign and less severe. There are not actual causes of brain cysts; however, they are mostly congenital. 

Brain cysts come in a variety of shapes and sizes. Our pediatric neurosurgeons see a lot of kids with arachnoid cysts, colloid cysts, and pineal cysts. Arachnoid cysts are the most frequent form of brain cyst, and they can arise anywhere in the brain, although they most usually occur in the temporal or posterior fossa.

Colloid cysts are typically discovered by chance and are treated if they are big or likely to cause hydrocephalus. Pineal cysts are fluid formations that develop on the pineal gland and are treated when they are big (greater than 2cm) and produce symptoms such as terrible headaches or issues with eye movement.

Large brain cysts can obstruct the normal flow of cerebrospinal fluid, resulting in increased brain pressure. Cysts can also leak into other parts of the brain, or blood vessels on the cyst's surface might bleed into it, resulting in a hematoma. Cysts can cause brain harm if left untreated.

Headache, nausea, vomiting, balance issues, seizures, visual loss, and hearing loss are all common symptoms of a brain cyst. The treatment of the cerebral cyst depends on its gravity and its volume, the fenestration, the shunt are therapeutic varieties for the simple cysts whereas the treatment of the tumoral cysts concerns the treatment of the tumor itself.