In the arachnoid cyst, the physician understands a collection of cerebrospinal fluid surrounded by the arachnoid (spiderweb-like meninges). The human brain has three layers of meninges, the middle layer consisting of thin and white collagen fibers.

What is an arachnoid cyst?

Arachnoid cysts are commonly found to be congenital malformations in the arachnoid (spiderweb-like meninges) that develop in the third trimester during early childhood development.
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The term arachnoid cyst refers to a cavity in the spiderweb skin (arachnoid) filled with cerebrospinal fluid (cerebrospinal fluid). This cerebral water-filled nascent protuberance of the meninges may be congenital or may be caused by external trauma, surgery or disease. Most of them remain undiscovered, but can also increase in size and cause discomfort.

The cysts are distinguished between intracranial and spinal meningeal. An intracranial arachnoid cyst is therefore located inside the skull or inside the skull. The spinal meningeal arachnoid cysts are located within the spine (intraspinal), but outside the spinal cord (extramedullary). They contain cerebrospinal fluid (cerebrospinal fluid).

causes

Arachnoid cysts are commonly found to be congenital malformations in the arachnoid (spiderweb-like meninges) that develop in the third trimester during early childhood development. Reasons for the formation of cysts may be medications, drugs or effects of radiation exposure. Arachnoid cysts are also associated with the consequences of meningitis.

Due to malformations develops in the middle meninges a bubble-like structure in which cerebrospinal fluid (brain water) collects. As the water increases, an arachnoid cyst is formed, either spinal or intracranial. Arachnoid cysts often show near the Sylvian fissure.

Other causes include inflammation of the brain (meningitis) and the nerve cell fibers of the spinal cord, circulation problems between the right and left hemisphere (corpus callosum) or the inherited autosomal dominant connective tissue disease (Marfan syndrome).

Symptoms, complaints & signs

Arachnoid cyst symptoms are rarely uncommon. However, a large number of cysts are discovered by chance as the result of an MRI or CT scan. As soon as an arachnoid cyst increases in size and thereby displaces surrounding tissue and organs, symptoms are indicated. Depending on the localization, it manifests itself in a very differentiated symptomatology.

Cystic dilatations can occur at different sites intracranially (within the skull), most commonly in the area of ​​the temporal brain. Sometimes they also occur in the area of ​​the Sellaregion behind the cerebellum. Intracranial arachnoid cysts can sometimes cause discomfort such as headache, increased intracranial pressure with nausea and vomiting.

Also cause increased fatigue, epileptic seizures, blurred vision, speech disorders or even symptoms of developmental delay as well as hormonal disorders in the form of premature puberty development. Sometimes, patients also notice personality changes.

Spinal arachnoid cysts can negatively affect the spinal cord and the circulation of cerebrospinal fluid through a permanent pressure effect on the nerve roots. Depending on localization, pressure on the spinal cord or nerve roots causes radiating pains in extremities such as arms and legs, gait insecurity, sensory disturbances. Paralysis or disorders of the bladder and bowel function.

Occasionally, external injuries are crucial for the development of a cyst. This can lead to bleeding, especially in minor injuries. However, there are often no symptoms, so the arachnoid cyst is discovered more by accident.

Diagnosis & History

If an arachnoid cyst is suspected, two important methods are used. Due to the exact soft tissue imaging, magnetic resonance imaging is often recommended. In this method, a three-dimensional model of the vessels is created by means of magnetic field technology, which specifically detects extensions in the brain or spinal cord.

This shows the cyst as a liquid-filled space. In rare cases, contrast medium enrichment of cerebral water also examines the condition between the cyst and the outer cerebral water spaces. The content of the cyst is shown on MRI at the same intensity as that of the cerebrospinal fluid (cerebrospinal fluid) and the contrast medium clearly shows the cyst wall. Adjacent tissue structures are included to differentiate the diagnosis.

As an alternative method, the ultrasound examination is particularly important for infants and children. The reflective sound waves produce images of structures within the body. A diagnostic sonography of arachnoid cysts takes only a few minutes.

If the presence of cysts is diagnosed, the doctor will take further steps. In a subsequent neurological examination, the functions of the brain and spinal cord are examined in order to rule out possible, yet unnoticed impairments. This is followed by checks on reflexes of the patient, sensitivity and motor functions. Blood collection with determination of the inflammatory parameters also indicates an arachnoid cyst.

complications

In most cases, the arachnoid cyst will only develop discomfort and symptoms as the cyst grows. For this reason, only a delayed or accidental diagnosis is usually possible. The enlargement of the cyst causes in most cases severe headaches, which arise due to the increased intracranial pressure.

Likewise, the patients suffer from vomiting and nausea and are extremely limited in their everyday lives. The severe headache can lead to concentration problems or sleep disturbances. There are also epileptic seizures associated with fatigue. As a rule, it is not possible to compensate for this tiredness through sleep.

Also, visual disturbances can occur suddenly. In children, due to the arachnoid cyst, developmental and intellectual disabilities develop. In some cases, the personality or attitude of a patient may also change significantly, which may negatively affect social contacts. Furthermore, paralysis occurs at various points of the body.

These can lead to a restriction of movement or gait disturbances. Often the patients also suffer from word finding disorders and speech disorders. The complications may persist even after the removal of the cyst if it is late. If removed early, consequential damage can be avoided.

When should you go to the doctor?

An arachnoid cyst does not necessarily have to be treated. However, if symptoms occur, a doctor must diagnose the cyst and remove it if necessary. Typical symptoms such as headache, visual and speech problems, nausea and vomiting, tiredness and epileptic seizures indicate a serious cause.

Although it is rarely an arachnoid cyst, almost always there is a disease that needs to be clarified and treated by a doctor. It is therefore advisable to go to the doctor with unusual symptoms that persist for more than a few days.

A diagnosed arachnoid cyst should be observed. If hormonal imbalances, developmental disability symptoms, or the aforementioned condition suddenly occur, the cyst may have increased. At the latest then an operative removal of the proliferation should take place.

Other warning signs requiring immediate medical attention include sensory disturbances, paralysis and insecurity in progress. Also suddenly occurring body aches and disorders of bladder and bowel function. If it comes to these complaints, it is: from the family doctor or neurologist and determine the cause.

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Treatment & Therapy

The treatment and therapy first requires a causal clarification. For this purpose, it is necessary to closely examine the current general condition of the patient and the risk factors for the corresponding therapy. Arachnoid cysts should only be treated surgically if symptoms occur.

Randomly discovered cysts require regular follow-up examinations using imaging techniques. However, as soon as the cyst causes a displacement that affects the blood circulation or the circulation of the cerebrospinal fluid, surgical treatment is necessary. There are several methods available for this.

The endoscopic cyst fenestration is a minimally invasive and gentle method. The cyst wall is opened endoscopically to provide a broad connection (marsupialization) to the natural cerebral water spaces of the brain base (cisterns) or to the cerebral chambers (cysto-ventriculo-stoma). to accomplish. If a severe cyst wall is present, the microsurgical technique is required.

In rare cases, the application of a cystoperitoneal shunt. This is a catheter that is inserted into the cyst. This directs the fluid under the skin by means of a pressure valve to the abdomen, where the draining brain fluid is absorbed. This method achieves a tremendous relief of brain water drainage failure.

Outlook & Forecast

The prognosis of an arachnoid cyst is generally classified as good. In the majority of cases, the cyst is removed immediately after diagnosis without further impairment and the patient can be discharged as cured. The procedure is usually uncomplicated and possible with little effort. The subsequent wound healing takes several weeks to complete. After that the person concerned is free of complaints.

This prospect of healing depends on the location of the cyst, the size of the cyst, and the health of the patient. The older the affected person is and the more pre-existing illnesses, the less favorable is the healing process. Nevertheless, in normal cases, the arachnoid cyst is removed completely permanently.

If the cyst is located in an inaccessible area, the likelihood of a good prognosis decreases. Removal can be associated with serious complications and lifelong impairments. The healing prospects are also reduced if the arachnoid cyst has already caused dysfunction of the body. Often these can not be corrected after a distance. Without treatment the further growth of the cyst threatens. This increases the risk of physical disorders and irreparable damage. In severe cases, the patient is threatened with life-threatening conditions.

prevention

Congenital arachnoid cysts can not be avoided by prevention. However, if they are aware of their existence, regular monitoring should be done by CT or MRI. Arachnoid cysts based on existing conditions, such as hypertension in diabetes mellitus, may be limited by primary treatment of the underlying disease.

This includes a deliberate change in lifestyle or, in the case of pronounced hypertension, the use of a drug therapy. With a timely diagnosis and subsequent surgery, the quality of life of those affected can be increased enormously.

aftercare

Arachnoid cysts are harmless in most cases and accordingly require no intensive treatment or follow-up care. If the cysts have already been diagnosed, follow-up by the neurologist should be done once or twice a year. If it comes to complaints, may require a surgical procedure in a specialist clinic.

After this procedure, follow-up procedures are limited to examining the brain by ultrasound and monitoring the medication. In addition, it must be ensured that the removal of the cysts has not led to neurological complaints. The patient should protect himself first and pay attention to unusual symptoms.

Aftercare also includes the creation of a complaint diary. It can be tracked whether cysts have formed again after months or years. If this is not the case, aftercare can be discontinued. Relapse is possible if the new cysts cause health problems.

Normally, arachnoid cysts are uncomplicated and require only irregular follow-up. Patients should contact the doctor if discomfort occurs after the removal of a cyst, or if side effects and interactions occur as part of the drug treatment.

You can do that yourself

Before an arachnoid cyst can be treated, the doctor must thoroughly evaluate it. Among other things, the actual therapy can be supported by strict personal hygiene and compliance with the medical guidelines.

As the cysts can occur in several parts of the body, the patient should check the armpits, back, genital area and other areas of the body that are not easily visible for noticeable skin changes every day. As a rule, an arachnoid cyst occurs in the area of ​​the brain, but in connection with other diseases serious skin diseases that affect the entire body can occur.

For this reason, a careful examination by a specialist in neurology must be performed. Persons suffering from meningitis should inform the doctor.

Other measures depend on the type and severity of the cyst. Small cysts can be surgically removed and usually promise a positive prognosis. Larger cysts, on the other hand, can cause neurological disorders that need to be treated separately. The patient should consult a physiotherapist early and take preventive measures. Therapeutic counseling significantly reduces the risk of psychological side effects.

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