The cause of a cyst of the 3rd ventricle of the brain. Colloid cysts of the third ventricle

Colloid cyst of the 3rd ventricle of the brain is a benign tumor of a round shape. The neoplasm is not oncogenic and does not spread metastases. The danger of a cyst lies in the possible stoppage of cerebrospinal fluid circulation and the development of a hydrocephalic symptom (dropsy of the brain).

A colloid cyst, which forms in the region of the 3rd ventricle of the brain, is often found in adult patients. This is a thin-walled benign tumor of gelatinous contents. Localization - anterior zones of the 3rd ventricle, sections near its roof, or the area of ​​the interventricular foramen of Monroe.

With small tumors, symptoms practically do not appear. If progressive growth is observed, the patient is tortured sudden attacks migraines, tinnitus and disorders visual function without obvious reasons. Treatment in most cases is only surgical - complete removal cysts and restoration of the path of movement of cerebrospinal fluid.

What causes the disease?

The reasons why a brain colloid cyst forms are not yet fully understood. Many experts say that a neoplasm begins to develop when it is not intrauterine development(the cyst is congenital). The fetus is affected by a complex of unfavorable factors:

• unhealthy lifestyle of the expectant mother;
• bad ecology;
• severe pregnancy (toxicosis);
• Rh conflict (especially in the first trimester);
• intrauterine infection.

The area of ​​embryonic tissue does not develop; its cells begin to secrete a viscous fluid, which is immediately separated by connective tissue. The initial size of the cyst is no more than 3 mm. Rapid growth is possible under the influence of provoking factors. Doctors include frequent stress, lack of sleep, excess weight and alcohol abuse (bad habits).

Features of the clinical picture

Cysts are usually asymptomatic, and main feature the beginning of active growth - acute headache. A colloid cyst of the third ventricle of the human brain usually manifests itself after a person reaches 30-40 years of age in the form of migraine, high blood pressure inside cranium and acute hydrocephalus (typical for advanced forms).

Other signs of a cyst:

• job change nervous system(changes and mental condition patient);
• gagging appears;
• unexplained seizures of epilepsy;
• feeling dizzy;
• leg weakness (due to stretching) nerve fibers, which go to the lower limbs).

In the most severe cases, it may occur death. Sudden death is explained by the increased pressure of the enlarged cyst on the zone regulating heart contractions.

Colloid cyst - more about the symptoms

The specificity of the severity of the clinical picture is conventionally divided into several subgroups.

1. Signs of tract blockage (carried sharp character). Typical manifestations include tinnitus, intolerable acute headache and the possibility of falling into a coma.
2. Symptoms with a gradual increase in pressure inside the skull - a violation central vision, convulsions, urge to vomit. The pain intensifies if the person lies down and does not stop after taking painkillers. There is depression of consciousness (drowsiness).
3. Violation of higher brain functions - memory problems, inhibition of mental operations, decreased intelligence.

As the cyst grows, it causes convulsions. They are generalized (shaking the whole body) or partial in nature (twitching of some muscles).

Note! A colloid cyst of the brain is also expressed by occlusive crises - a brief stop in the paths of movement of the cerebrospinal fluid. It is observed with a sudden change in body position. Crises are characterized by burning pain and redness of the facial skin, rapid breathing, fever or chills. It goes away on its own.

Features of diagnostic methods

If you suspect a colloid cyst, you should see a neurologist or neurosurgeon. Diagnosis begins with collecting anamnesis - establishing symptoms and provoking factors of development. It is important to identify previous illnesses (exclude complications).

The next stage is the analysis of complaints and examination of the patient. For installation accurate diagnosis also used instrumental methods research.

1. X-ray (the colloid cyst appears as a darkened spot in the images).
2. CT ( CT scan) – the neoplasm in the image is round and whitish.
3. MRI allows you to determine the exact location of the cyst and analyze its effect on neighboring brain structures.

You should also visit an ophthalmologist for consultation. The specialist will prescribe additional examination(ophthalmoscopy). The method will allow you to assess the condition of the fundus, identify disc swelling and the nature of retinal damage.

How to get rid of a cyst?

Colloid cyst of the 3rd ventricle of the brain, treatment involves surgery. Surgical intervention carried out taking into account the patient's age, characteristic manifestations and size of the neoplasm.

For reference! When threatened sudden death surgery is prescribed if the cyst exceeds 1.4-1.6 cm in diameter (if typical symptoms not expressed).

The main goal of the operation is to completely remove the colloid cyst, clear the cerebrospinal fluid ducts, and relieve the symptom of increased pressure inside the skull. Various techniques are used to remove the tumor.

1. Endoscopic removal involves making a small hole in the bones of the skull using a special medical instrument. As a result, the neurosurgeon examines the affected area and removes the cyst.
2. Craniotomy (or open surgery) - this is opening the skull and carrying out further manipulations directly on the brain. Allows you to remove the cyst and restore the pathways for the movement of cerebrospinal fluid. Disadvantages: increased risk of injury and cosmetic defects after surgery.

Bypass surgery is prescribed according to urgent indications. A special device is inserted into the ventricle, which sucks out the fluid (removes accumulated cerebrospinal fluid). After the patient has returned to normal, it is necessary to remove the colloid cyst.

In neurological departments, patients are observed whose colloid cyst does not exceed the permissible size. For the treatment of these patients, a special tactic has been developed: surgery is not prescribed, the patient undergoes regular examination (as well as MRI and CT). Based on the information received, the size of the cyst and its tendency to grow are assessed. If the clinical manifestations are pronounced and the size of the tumor is normal, an urgent consultation with a neurosurgeon is indicated.

To summarize: prognosis and rules of prevention

Small size disease cystic tumor It has favorable prognosis. This pathology does not affect general well-being. If the tumor grows and the patient refuses treatment, the prognosis is extremely unfavorable. Hydrocephalus begins to develop, which can cause death (the work of the heart muscle is disrupted, and when the brain is pressed in and important centers are pinched, breathing becomes difficult).

Note! In most cases, after surgery to remove a cyst from the 3rd ventricle of the brain, patients experience complete recovery.

A colloid cyst in the brain may bypass you if you follow simple rules prevention.

1. After reaching 40 years of age, it is important to visit a therapist, neurologist and cardiologist in a timely manner.
2. Avoid hypothermia.
3. Treat infectious diseases promptly and appropriately.
4. Watch your diet (cholesterol should not exceed the norm).
5. Monitor your blood pressure and blood pressure readings.

A cyst of the third ventricle of the brain is not a terrible death sentence, which will certainly bring irreversible consequences. See a qualified doctor, do not self-medicate, and attend regular checkups. Taking your body seriously will help you stay healthy. long years forward.

Removal of colloid cyst of the 3rd ventricle - surgery

Shkarubo M.A.

Description

Colloidal cysts III ventricles are rare, slowly growing non-tumor benign formations of the brain. In the vast majority of cases, colloid cysts are located in the anterior sections III ventricle.

Clinic

Clinical manifestations of colloid cysts vary from complete absence symptoms (accidental findings during neuroimaging - CT, MRI), to serious life-threatening manifestations. Most often, colloid cysts occur in young people from 20 to 40 years old.

Basic typical manifestations colloid cyst:

Occlusive attacks

Colloid cysts, located in the anterior sections of the third ventricle, like a valve, periodically close the opening between the lateral ventricles of the brain (foramen of Monroe), thereby disrupting the normal circulation of cerebrospinal fluid (CSF) in the ventricles of the brain. This is manifested by severe paroxysmal headaches, often accompanied by nausea and/or vomiting, sudden weakness in the legs, fainting conditions, short-term loss of consciousness without convulsions up to several times a day. In rare cases, when the foramen of Monroe closes to long time, sudden depression of consciousness develops up to coma and death.

Hydrocephalic symptoms

Due to long-term disruption of the normal circulation of cerebrospinal fluid caused by a colloid cyst, expansion of the ventricular system occurs - hydrocephalus. Clinical manifestations of hydrocephalus are constant headaches, memory impairment, dizziness and unsteadiness when walking, and urinary incontinence.

Memory impairment

Colloid cysts, squeezing and/or merging with the vault of the brain (Latin “Fornix” - the structure of the brain responsible for memory), cause memory impairment in 35% of cases. Memory impairments can range from mild, detected only by special neuropsychological tests, to severe, noticeable to the naked eye.

Diagnosis of colloid cysts

If a brain tumor is suspected, a CT or MRI is performed. In 8% of colloid cysts there are no obvious clinical manifestations, appearing as an accidental finding during radiation diagnostics.

Treatment

If the colloid cyst is an accidental finding, does not manifest any symptoms, is small in size, and there are no signs of hydrocephalus on MRI, then dynamic monitoring of the patient is possible. However, it is worth remembering that colloid cysts, while not being a tumor disease of the brain, can suddenly increase in size and cause severe symptoms.

Open surgery is the microsurgical removal of a colloid cyst

A small trepanation and removal of the colloid cyst is performed using a microscope and microsurgical instruments.

Endoscopic surgery

This method of removing colloid cysts is a minimally invasive method of surgical treatment, since the operation is performed without craniotomy. The endoscope is inserted through a small hole in the skull, through which the cyst is removed.

Bypass operations

Palliative interventions aimed at resolving cerebral hydrops. A shunt system is implanted into the ventricles of the brain, which diverts cerebrospinal fluid into abdominal cavity. As a rule, bypass operations are performed for urgent indications. After the patient's condition improves, subsequent removal of the colloid cyst is recommended.

All treatment methods have their advantages and disadvantages. Indications are always determined individually by the neurosurgeon.

Due to the rarity of the disease, it is advisable to concentrate patients in clinics where there is experience in performing such operations.

The Research Institute of Neurosurgery has the largest global practice in the treatment of colloid cysts of the third ventricle. Our many years of experience show that the best surgical method The treatment for colloid cysts is microsurgical removal.

Colloid cysts

Colloid cyst of the brain in the region of the third cerebral ventricle occurs in 10%-15% of cases of tumors of this localization. Colloid cyst of the brain in the third ventricle is the most common pathology in adults.

Prevalence

Accounts for 0.5-1% of all brain tumors. It is mainly diagnosed at the age of 30-40 years, extremely rarely - in childhood and infancy. Until 1994, only 37 cases in children were described.

Pathology

Colloid cyst of the brain It is a thin-walled benign formation with gelatinous content and is located in the anterior parts of the third ventricle in the area of ​​its roof, in the projection and below the interventricular foramen of Monroe. They can obstruct the foramen of Monroe, leading to acute hydrocephalus, and are a recognized cause of sudden death.

Histologically: a single or pseudostratified lining of cuboidal or columnar epithelium, which includes mucous goblet cells and scattered ciliary cells. The epithelium is located on thin layer connective tissue and produces mucin-like (gelatinous) contents, which accumulate under pressure within the cyst capsule. Brain cysts with hemorrhagic contents have been described in children.

The origin is debated, traditionally (Kappers, 1955) it was considered to originate from the diencephalic vesicle or persistent embryonic paraphysis. The paraphysis develops from a budding of the roof of the hypothalamus dorsal to the interventricular foramen at 7 weeks embryonic development, and completely disappears 3.5 months after birth. A colloid cyst may develop from this detached, nonreversible embryonic vesicular pocket. Shuangshoti, 10 years later, suggested that this cyst may develop from neuroepithelium, including the ependyma and choroid plexus, and proposed the term "neuroepithelial cyst". In 1992, using immunohistochemistry, Tsuchida et al. The non-neuroepithelial nature of the cyst was suggested, emphasizing the similarity of its epithelium with that of the respiratory tract (trachea and main sinus). Ho and Garcia found the following ultrastructural features of the cyst: ciliary cells and nonciliary cells with microvilli, cup-shaped cells with secretory granules, and basal cells together with undifferentiated cells with a small number of organelles. Desmosomes were also found - characteristic feature epithelial cells that promote their connection. The epithelial lining of the cysts ultrastructurally resembled the respiratory epithelium, that is, the lining of endodermal origin. Therefore, it was assumed that colloid cysts and Rathke’s pouch cysts are similar formations, but different localization. The contents of cysts are the secretion of epithelial cells and the products of its breakdown; sometimes signs of old and recent hemorrhage are also revealed, as well as cholesterol and colloid, which can lead to a secondary xanthogranulomatous reaction in the cyst wall, which histologically appears as multiple “foam” cells, chronic inflammatory infiltrates , epithelial cells and multinucleated giant cells.

Clinic

IN childhood Colloid cysts are often asymptomatic and rarely cause headaches. In adults, 68-100% of patients experience headache, increased intracranial pressure, obstructive hydrocephalus.

Radiological findings

The wall is flat, smooth, dimensions 3-40 mm, but can be larger. Size does not affect the course or prognosis, and even small ones can lead to sudden death. The vast majority occur in the anterior parts of the 3rd ventricle, rarely in the lateral, fourth, or even outside the ventricles. MRI is superior to CT in lesion characterization. What CT and MRI have in common is that the formation:

• rounded.
• sharply demarcated focus.
• localization - foramen of Monroe
• sizes from a few millimeters to 3-4 cm.

CT

As a rule, a homogeneous round hyperintense formation is visualized in the area of ​​the roof of the third ventricle. Calcification is rare and hypodense or isodense density is also rare for this formation.

MRI

• T1
  • in 50% of cases there is a hyperintense signal
  • less often hypointense or isointense signal
• Т1+Gd
  • thin ring type reinforcement
• T2
  • variable signal
  • often hypointense
  • less often hypointense in the center and hyperintense along the periphery
  • less often homogeneous high signal
• Flair
  • often a hyperintense signal and a signal higher than the signal from the cerebrospinal fluid.

Differential diagnosis

• calcified or hyperdense meningioma.
• giant cell astrocytoma.
• pilocystic astrocytoma.
• blood in the area of ​​Monroe's foramen.

The human brain is a complex and amazing structure, all the mysteries of which scientists have not yet unraveled. One of the most interesting mechanisms of the functioning of the nervous system remains the process of formation and circulation of cerebrospinal fluid (CSF), which is carried out using the 3rd ventricle of the brain.

3rd ventricle of the brain: anatomy and physiology

The third ventricle of the brain is a thin slit-like cavity, bounded by the visual tuberosities of the thalamus and located in diencephalon. The inside of the third ventricle of the brain is lined soft shell, branched choroid plexus and filled with cerebrospinal fluid.

The physiological significance of the 3rd ventricle is very great. It ensures unimpeded flow of cerebrospinal fluid from the lateral ventricles into the subarachnoid space for washing the brain and spinal cord. Simply put, it ensures the circulation of cerebrospinal fluid, which is necessary for:

• regulation of intracranial pressure;
• mechanical protection of the brain from damage and injury;
• transport of substances from the brain to spinal cord and vice versa;
• protecting the brain from infection.

3rd ventricle of the brain: normal in children and adults

A normally functioning liquor system is an uninterrupted and harmonious process. But if even a small “breakdown” occurs in the processes of formation and circulation of cerebrospinal fluid, this will certainly affect the condition of the child or adult.

The 3rd ventricle of the brain is especially important in this regard, the norm of which is indicated below:

1. Newborns -3-5 mm.
2. Children 1-3 months -3-5 mm.
3. Children 3 months - 6 years -3-6 mm.
4. Adults -4-6 mm.

Common diseases of the third ventricle of the brain

Most often, the problem of impaired outflow of cerebrospinal fluid occurs in children - newborns and babies up to one year old. One of the most common diseases at this age is ICH () and its complication – hydrocephalus.

During pregnancy future mom passes mandatory ultrasound fetus, which allows us to identify birth defects development of the child’s central nervous system is still early stages. If during the examination the doctor notes that the 3rd ventricle of the brain is dilated, additional diagnostic tests and careful medical supervision.

If the cavity of the 3rd ventricle in the fetus becomes more and more dilated, in the future such a baby may require bypass surgery to restore the normal outflow of cerebrospinal fluid.

Also, all babies born at the age of two months (earlier if indicated) undergo mandatory medical checkup a neurologist who may suspect dilatation of the 3rd ventricle and the presence of ICH. Such children are sent to special examination brain structures – (neurosonogathia).

What is NSG?

Neurosonography is a special type ultrasound examination brain It can be performed on infants because they have a small physiological opening in the skull - the fontanelle.

Using a special sensor, the doctor receives an image of all internal structures brain, determines their size and location. If the 3rd ventricle is dilated in the NSG, more detailed tests are performed - computed tomography (CT) or magnetic resonance imaging (MRI) to obtain a more accurate picture of the disease and confirm the diagnosis.

Which doctors should you contact when diagnosing ICH?

If the 3rd ventricle of the baby’s brain is slightly enlarged and the mother has no serious complaints, regular monitoring by a local pediatrician is sufficient. Consultation with a neurologist and neurosurgeon is necessary if there is significant dilatation of the ventricles on ultrasound or symptoms of ICH:

• the child began to suck the breast worse;
• the fontanel is tense, protruding above the surface of the skull;
• the saphenous veins of the scalp are dilated;
• Graefe's symptom - a section of white sclera between the iris and eyelid when looking down;
• loud, sharp cry;
• vomit;
• divergence of the sutures of the skull;
• rapid increase in head size.

Doctors determine further treatment tactics for a baby with: conservative means prescribing vascular drugs, massage, physiotherapy; surgical – performing an operation. After therapy, children quickly recover, the activity of the nervous system is restored.

Colloid cyst of the 3rd ventricle is a disease common among adults 20-40 years old. It is characterized by the appearance of a benign round formation in the cavity of the 3rd ventricle, not prone to rapid growth and metastasis.

The colloid cyst itself does not pose any danger to human health. Problems begin if it reaches a large size and interferes with the outflow of cerebrospinal fluid. In this case, the patient experiences neurological symptoms associated with increased intracranial pressure:

• severe headache;
• vomit;
• visual impairment;
• convulsions.

Diagnosis and treatment of colloid cyst of the third ventricle is carried out jointly by a neurologist and a neurosurgeon. If the size of the formation is pronounced, determined on CT or, surgical treatment of the cyst is prescribed. After the operation, the normal flow of cerebrospinal fluid is quickly restored, and all symptoms of the disease disappear.

Summing up

Thus, the third ventricle is important element liquor system, diseases of which can lead to serious consequences. Attentive attitude to health and timely appeal Doctors will help you quickly and permanently cope with the disease.

COLLOID CYSTS
Introduction
First description of colloid cysts in 1958 (Wallmann).
In 1921, Dandy performed the first successful cyst removal.
Benign formation, which can lead to fatal outcome due to its location. These benign tumors almost always located in the third ventricle (cases of a colloid cyst being located in the area of ​​the septum pellucida, in the fourth ventricle have been described) and are therefore associated with obstructive hydrocephalus and lead to increased intracranial pressure.
Despite the fact that they are congenital, they appear extremely rarely in childhood. As a rule, colloid cysts appear between the ages of 20 and 50 years. Description of the early manifestation in a 2 year old child.
Colloid cysts account for 0.5% - 1% of all primary brain tumors and 15-20% of intraventricular tumors.
Pathophysiology
Over time, they increase due to the increase in the amount of content. An increase in the amount of contents of a colloid cyst occurs in some ways - secretion production epithelial cells, accumulation of blood breakdown products and cholesteol crystals in the cyst.
Clinical picture
A colloid cyst is associated with the classic symptoms of obstructive hydrocephalus with a paroxysmal increase in headache depending on the position of the head. In addition to headaches, dizziness, memory loss, behavioral disorders. Sudden weakness in the limbs without loss of consciousness has also been described.
Other symptoms are associated with increased intracranial pressure - disc swelling optic nerve, vomit.
With a colloid cyst, there may also be symptoms of normal pressure hydrocephalus (dementia, memory impairment, urinary incontinence).
Anatomy
A colloid cyst usually occurs in the anterior part of the third ventricle between the crura of the fornix. The cyst is fused to the bottom of the third ventricle and often to the choroid plexus. Cysts are located directly above the foramen of Monroe. Rare cases of colloid cysts have been described in the area of ​​the septum pellucida, fourth ventricle and sella turcica.

Diagnostics
1. CT scan of the brain - homogeneous, 2/3 high density, 1/3 of normal density compared to surrounding tissues. They are round in shape. Sometimes, after contrast, a thin rim may form around the colloid cyst. The size of the tumor of the third ventricle varies between 5-25 mm.
2. CT has important for planning surgery, since CT data, compared to MRI data, provide a clearer picture of the degree of viscosity of the cyst contents. The contents of colloid cysts, which on CT scan look increased density, has high viscosity and drainage poses certain difficulties.

MRI of the brain
1. In T1 mode - a hyperintense signal, in T2 mode - a hypointense signal.
2. The variability of the MR signal does not correlate with the fluid content in the cyst. MRI is important for differentiation from basilar artery aneurysm.

It is also necessary to consult an ophthalmologist to determine diplopia, increased intracranial pressure, and a neuropsychologist to assess the state of memory and behavior.

There is no drug treatment for this pathology.
Surgery aimed at resolving hydrocephalus and eliminating the deterioration of the clinical condition.
If the patient's condition is severe, he is in stupor, ventricular drainage (often bilateral) is indicated. If the patient is conscious and the patient's condition is stable, removal of cerebrospinal fluid is contraindicated, since a decrease in the size of the ventricles creates difficulties for performing a neurosurgical operation.

Indications for neurosurgical treatment
The presence of a colloid cyst associated with clinical picture hydrocephalus is an indication for neurosurgical intervention.
Cases of sudden death in the presence of a colloid cyst of the third ventricle of the brain have been described. The likelihood of sudden death is not directly related to the size of the tumor, the degree of hydrocephalus and dilatation of the ventricles of the brain. Fortunately, the likelihood of sudden death is low.

Introoperative details
The tumor of the third ventricle (colloid cyst) is removed transcortical, transcallosal and endoscopic.

Transcortical route - a corticectomy is performed in the middle frontal gyrus, access to the foramen of Monroe is made through the anterior horn of the lateral ventricle, the cyst is dissected and aspiration (removal) of the internal contents is performed. In this case, injury to the cerebral vault is undesirable, which can lead to reversible memory impairment.

Transcallosal approach - in this case the cerebral cortex is not dissected. Access is made to the corpus callosum, in the body area it is dissected to a length of 1 cm, and access is made to the lateral ventricle. The foramen of Monroe is visualized, and the septum pellucidum is separated to visualize the opposite foramen of Monroe.

Endoscopic access - through a small trefination hole (1.5 cm in diameter) transcortically through the anterior horn of the lateral ventricle, access is made to the foramen of Monroe, the cyst is punctured, and the contents are aspirated.