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A brain cyst is a fluid-filled sac in the brain which may contain blood, pus, cerebrospinal fluid or other material. Brain cysts can form during the first few weeks when a baby is growing in the uterus or because of a head injury. In other cases, there may be a link between a brain cyst and a benign tumor or malign tumor.
Even if a brain cyst isn’t a malignant tumour, it can still cause problems by pressing against brain tissue and cause symptoms, such as headache, vision problems, or nausea. If this happens, you may need surgery to remove the cyst. In some cases, if the cyst is small and not growing and is unlikely to cause symptoms, it may be advisable to watch it instead of treating it with surgery.
There are different types of brain cysts:
Brain cysts are caused by the building up of fluid in an area of the brain.
Brain cysts can form during the first few weeks when a baby is growing in the womb. The exact cause of congenital cysts is unknown, but some people may have a genetic predisposition.
Some types of cysts, might form because of a head injury or other trauma to the brain.
In other cases, there may be links between a brain cyst and a benign or cancerous tumor.
The symptoms generally depend on which part of the brain the cyst is growing in. In some cases, a small cyst may not cause any symptoms. Some cysts are “silent” (cause no symptoms) until they grow large. In some cases, you may have a problem related to the area of the brain the cyst is growing in. In other cases, the symptoms may be due to blockage of the normal flow of CSF. This can cause increased pressure on the brain (intracranial pressure).
Symptoms may be different for each person, but can include:
In some cases, your doctor may discover a brain cyst when it shows up on a imaging scan done for other reasons. In other cases, you may be having symptoms related to the cyst. Your doctor will likely refer you to a neurologist (who specializes in diagnosing and treating diseases of the central nervous system) or a neurosurgeon (a surgeon specialized in performing brain or spinal cord surgery).
The process to diagnose a cyst starts with a medical history and a physical exam. Your doctor will ask about your symptoms and past medical conditions as well as your family’s medical history. The physical exam may include a nervous system exam. Imaging tests may be done to look at the brain. Contrast medium may be used to help show more detail in the images. The tests may include:
CT scan. This is an imaging scan that uses X-rays and a computer to make detailed images of the body. Scans may be done of your brain and spinal cord.
MR scan. This test uses large magnets and a computer to create images of the body. MR scans of your brain and spinal cord may be done to get more information about the cyst and nearby tissues.
Scans may be repeated over time to learn if the cyst is growing.
Treatment can vary by the type of cyst.
If you have an arachnoid cyst, your healthcare provider may puncture the cyst sac and drain the fluid. The fluid drains into the CSF or is pulled out with a needle. If your provider drains the cyst without removing part of the sac or by placing a permanent draining tube, the sac may fill with fluid again.
If you have a dermoid or epidermoid cyst, your healthcare provider will likely remove completely together with its sac. If the cyst isn’t fully removed, it may regrow and cause symptoms again after a few years.
Colloid cysts often cause a buildup of excess CSF. This is known as hydrocephalus and can create a dangerous increase in pressure within the brain. A shunt or drainage tube can relieve this pressure. Colloid cysts can be hard to remove because they are often located deep within the brain. To remove these, your healthcare provider may use special surgical methods with tiny endoscopic tools operated through a thin tube into the brain.
Pineal cysts often cause no problems and its possible to manage them by watching for any changes.
Tumor cysts can be treated with surgery, radiotherapy, or chemotherapy, alone or combined.
Abscesses are treated with antibiotics, antifungals, or antiparasite medicines. Surgery may be required in some cases.
The supraorbital approach through the eyebrow is effective for many patients with meningiomas, craniopharyngiomas and other tumors that located near the optic nerves and pituitary gland, as well as gliomas and metastatic brain tumors that are positioned in the frontal and temporal lobes.
This versatile, minimally invasive approach minimizes normal tissue disruption and brain retraction, allowing for a more direct approach to treating these lesions. Occasionally, an abdominal fat graft may be necessary to seal large nasal sinus defects.
This approach is typically performed with the assistance of an endoscope, allowing for detailed visualization of the area that will be treated. Patients recover well after the surgery and are satisfied with the cosmetic results as well.
Tumors of the frontal or middle fossa are today normally treated usind this surgical approach instead of the traditional pterional (fronto-temporal) or bi-frontal craniotomies that involve larger scalp incisions and bony openings. Endoscopy and minimally invasice surgical instruments allow excellent access to treating tumors through very small openings.
Endoscopic endonasal surgery is a state-of-the-art procedure that involves accessing the pituitary gland and surrounding structures through the nasal canals, eliminating the need for traditional open surgery. This technique utilizes a high-definition endoscope, a thin and flexible tube with a light and camera, which allows surgeons to visualize and access the surgical area with precision. The endonasal approach uses the nostrils as natural surgical corridors to remove pituitary adenomas, and many skull base brain tumors.
The endonasal route is the preferred surgical approach for almost all pituitary adenomas and Rathke’s cleft cysts, as well as most craniopharyngiomas, clival chordomas and many midline menigiomas. Utilizing high-definition endoscopy (surgical telescope), surgical navigation (“GPS for the brain”) and Doppler ultrasound for carotid artery localization, the endonasal approach has evolved into a safe and effective procedure in experienced hands. Major advantages of the endonasal route are: avoidance of brain retraction, minimal or no manipulation of the optic nerves, no facial incisions and rarely any need for nasal packing.
Our surgeons have one of the world’s largest experiences in endoscopic endonasal skull base surgery for all types of pituitary adenomas and midline brain tumors.
The retromastoid approach (also known as the retrosigmoid approach) uses a small surgical opening behind the ear to reach and remove acoustic and trigeminal schwannomas, meningiomas, epidermoid tumors, and tumors of the cerebellum such as hemangioblastomas and metastatic brain tumors.
It is also the main approach for microvascular decompression of the cranial nerves (for trigeminal neuralgia or hemifacial spasm). This operation has been augmented with the introduction of the endoscope, allowing for visualization around corners, limiting the need for extensive tissue removal or brain retraction.
Occasionally, an abdominal fat graft is necessary to seal the opening and prevent a cerebrospinal fluid (CSF) leak.
Overall, this operation is associated with great access to the surgical area with minimal cosmetic or soft-tissue damage and relatively quick patient recovery.
The gravity-assisted Trans-Falcine approach is ideal for the resection of meningiomas, gliomas (astrocytomas, ependymomas, oligodendrogliomas, intraventricular tumors) and metastatic brain tumors.
By using gravity surgeons allow for the brain to change its position, removing the need for brain retraction and allowing the surgical instruments to reach and treat deep lesions in the brain. The angled endoscopes allow for excellent visualization and safe tumor resection.
Compared to traditional approaches, patients have a relatively quicker recovery and increased preservation of neurological function.
The Trans-Tentorial approach is ideal for patients with certain pineal tumors and cysts, gliomas, metastatic tumors and cerebral cavernous malformations of the inferior-medial posterior temporal and occipital lobes.
This surgical approach takes advantage of the structures separating the cerebral cortex from the other structures of the hindbrain and brainstem, minimizing the need for brain retraction.
The operation is performed in a sitting position to achieve this relaxation of the brain. Patients have to undergone a pre-operative cardiac evaluation to ensure safe surgical outcomes. This procedure is performed endoscopically, allowing for improved visualization and a smaller craniotomy.
Compared with other approaches, it has less risk to the occipital lobes (vision processing region) and decreased resection of tissues.
Brain path procedure, or Brainport approach can be performed to remove gliomas, metastatic brain tumors, cerebral cavernous malformations and blood clots deep within the brain, that were previously considered inoperable, while minimizing the risk of damaging the surrounding dense and delicate neural structures that control brain and body functions.
Using the fiberoptic tractography and BrainPath®, our neurosurgeons can more safely remove many tumors that were tumors and blood clots, delivering the best outcomes for patients.
Using imaging and navigation systems, the BrainPath® device is inserted into the brain through a small opening. Its cone-shaped sheath slips through the dense and sensitive white matter tracts of neural networks to the location of the tumor or clot.
With the aid of high-powered optical tools, the NICO Myriad®, is inserted through the sheath. The device, which is about the diameter of a pencil, is used to remove the tumor or clot. This approach may result in less blood loss and faster recovery for patients.
The Myriad® device also has a filter to capture the targeted tissue in a sterile and intact form to be used for pathological analysis and if needed, for genomic tumor sequencing.
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