In the process of intrauterine development of the child, his brain also constantly develops. New departments and partitions appear, gray matter, protective membranes and connective tissues. However, under the influence of some factors, the baby's brain is deformed and damaged even before it is born. As a result, neoplasms occur in its cavities. One of these is subependymal cyst in newborns.
The process of neoplasm formation
Ependyma is a neuroepithelium lining the inside of the central channel of the spinal cord and the ventricular cavity. Most often it is he who serves as the source of the formation of cystic formations. This process is accompanied by activation of cell hyperplasia and a slowdown in their natural differentiation. The neoplasm can be localized both on top of the ependyma and under this layer.
Various pathological effects lead to circulatory disorders in the brain. Against the background of a deficiency of oxygen and nutrients, a necrotic area is formed, located subependymally. Due to the necrosis of cellular elements, a cavity with a liquid inside arises. This is a cyst.
The concept of subependymal cyst in newborns
This neoplasm represents a structural change in the brain substance of a benign nature. It can be combined with cystic plexuses, accompanied by severe neurological symptoms, or asymptomatic. As a rule, pathology is congenital in nature, and is formed in utero or during childbirth.
Main reasons
The main cause of the appearance of neoplasm is considered fetal hypoxia - oxygen deficiency. Therefore, after confirming this diagnosis, the pregnant woman should undergo appropriate treatment. Subependymal cysts in newborns are formed under the influence of the following factors:
- Cerebral ischemia. Pathology contributes to the appearance of negative changes in the supply of certain areas of the brain with blood. As a result, empty cavities form, which eventually fill with liquid. With small sizes of the cyst, specific therapy is not required. In the case of vomiting, convulsions and inhibition in development, it can be assumed that the neoplasm increases in size. In such a situation, it is advisable to resort to medical care.
- Brain hemorrhages. They are especially dangerous during fetal development. Hemorrhage may be preceded by infection of the fetus with an infection, birth injury, or acute hypoxia.
- Against the background of acute or moderate oxygen deficiency, the fetal body malfunctions. Hypoxia usually develops with anemia, toxicosis, or Rh conflict.
The factors provoking an ailment should include drug or alcohol dependence of the pregnant woman, frequent stresses and exposure to ionizing radiation.
What are pseudocysts?
In medical sources you can often find the concept of "pseudocysts". Unlike true neoplasms, they are not a pathology. They are formed by the penetration of cerebrospinal fluid into the vascular plexuses of the ventricles of the brain of a child after it is born. Pseudocysts are characterized by small size and rounded shape. They do not grow, but participate in the production of cerebrospinal fluid, which is necessary for the full functioning of the brain.
Subependymal pseudocysts are detected only by instrumental diagnostic methods. They do not possess a pronounced clinical picture. After some time, they usually resolve on their own.
Symptoms and localization
In areas of tissue necrotization, subependymal cysts are formed in a newborn child. To the left or right, symmetrically, they can be in the region of the middle sections. In this case, the symptoms of the disease are closely related to the localization of the pathological focus. Different parts of the brain are responsible for certain functions. When the tissues are compressed, their work is disrupted.
- Occipital area. It controls the visual apparatus. Therefore, when it is defeated, the child has problems with visual perception: hyperopia / myopia, blindness.
- Temple area. Responsible for hearing, which in the case of cystic formations may worsen or disappear altogether.
- Cerebellum. Determines the coordination of movements. As a result of the compression of his tissues, problems with holding toys, sitting or walking appear.
- Pituitary. This part of the brain produces hormones, including those responsible for growth. With its defeat, developmental delays are observed.
- Frontal lobes. When this zone is affected, a malfunction occurs in the stages of speech formation, which is manifested by late walk or babble.
General clinical signs
Subependymal cyst in a newborn baby on an ultrasound scan looks like a spherical formation. Its dimensions can vary from a couple of millimeters to several centimeters. Cysts can be located symmetrically, only on the left or on the right. The stronger the child underwent hypoxia in utero, the greater the volume of brain tissue will be damaged.
Small subependymal cysts in a newborn usually do not manifest themselves. Moreover, by the end of the first year of life, they independently resolve. However, with large or multiple formations, the corresponding clinical picture appears. Common signs for pathology include:
- sleep disorder and causeless constant crying;
- hyper excitability or lethargy, lethargy;
- tendency to muscle hypertonicity;
- weak sucking reflex;
- poor weight gain;
- tremor of hands and feet, chin;
- hearing and vision impairment;
- fontanel bulging;
- convulsive syndrome.
The listed symptoms can be expressed to varying degrees. In especially serious cases, and as the child grows, developmental lag, problems with speech and learning become noticeable.
Varieties of pathology
The characteristic features of subependymal cysts determine the tactics of treatment. Depending on the size of the neoplasm, they are small (up to 3 cm) and large. The larger the cyst, the higher the likelihood of a child developing problems.
According to the growth trend, doctors distinguish the following types of pathology:
- increasing (require surgical intervention, since tissue compression negatively affects the work of the whole brain);
- not increasing (in this case, the forecast is usually favorable).
By the number of chambers, subependymal cysts in a newborn baby are divided into single-chamber and multi-chamber. In the latter case, the diagnosis may be difficult. Multicameral neoplasms are characterized by symptoms characteristic of other pathologies.
Diagnostic Methods
The main method for detecting an ailment is neurosonography. This is an ultrasound diagnostic method that does not harm the newborn. The procedure is carried out in the first few days after birth, if the pregnancy proceeded with pathologies, and the birth was difficult. After closing the fontanel, an MRI is recommended. Such procedures are repeated several times a year to monitor the dynamics of growth and development of subependymal cysts in a newborn baby.
Doctors' reviews indicate that if a herpetic or cytomegalovirus infection is suspected, an immunological diagnosis is prescribed. It allows you to accurately diagnose and select therapy. Immunological diagnostics is a complex of complex and expensive procedures that are available only in large cities. On the other hand, they do not allow to evaluate the nature of brain damage. Therefore, today doctors are increasingly resorting to echoencephalography as an additional method of examination. With its help, you can determine the degree and nature of damage to brain structures.
Treatment features
Therapy for subependymal cysts of the brain in a newborn is aimed at slowing its progression. In addition, medical appointments always depend on the age of the patient.
In case of hypoxia during childbirth, resuscitation measures are performed in the first minutes after the birth of the baby. Liquid is removed from the trachea, oropharynx and nasopharynx. In severe cases, an oxygen mask is used. Newborns born in conditions of deep hypoxia may need mechanical ventilation. They are prescribed detoxification measures.
In the first three days, the patient’s condition is constantly monitored by a neuropathologist. To stabilize the condition, drugs, physiotherapy and a massage course are prescribed. These measures contribute to the elimination of oxygen starvation. Usually prescribed "Diacarb", "Asparkam", an injection of vitamin B12.
During the growth of the child, it is important to constantly monitor the pathology. Additionally, the doctor may prescribe drugs to stimulate speaking and improve the psycho-emotional background. If necessary, the treatment is supplemented by consultations with a speech therapist, psychologist.
In adolescence, children are prescribed vitamin complexes. They positively affect the functioning of the brain and normalize metabolic processes. It is important to timely fill the deficiency of a certain group of hormones with appropriate drugs. Only in this case the child will feel good.
If the subependymal cyst in the head of a newborn is actively growing, surgical intervention is recommended. The operation is carried out in one of the following ways:
- shunting (fluid is removed from the neoplasm);
- endoscopic intervention (removal of the neoplasm is carried out by a minimally invasive technique);
- craniotomy (this is a serious neurosurgical operation).
After the intervention, a small patient is prescribed immunostimulating, general strengthening and anti-inflammatory drugs.
Prognosis for recovery
A small subependymal cyst in a newborn on the left or on the right does not pose a threat. Such a child will fully develop physically and mentally. However, even slight growth can lead to negative consequences. In this case, a small patient is immediately prescribed surgery. Subsequently, a neurologist's health monitoring is required.
Possible complications
As already noted above, the negative consequences of the disease are possible only with the growth of the neoplasm, provoked by hypoxia, infections or other pathogenic factors. At the same time, characteristic changes in physical or mental development appear approximately 2-3 years after birth, and not in infancy. In such situations, you can observe:
- speech delay, memory impairment;
- anemia;
- irritability, excessive tearfulness;
- pathology of the cardiac and vascular systems;
- disturbances in the functioning of the bronchopulmonary apparatus.
Such deviations require qualified medical assistance, consultation with specialized specialists (speech therapist, psychologist).
Doctors opinions and reviews
Subependymal cyst in newborns is a fairly common pathology. It is diagnosed in every tenth child. Faced with a similar problem, parents often do not know how to behave properly. On the other hand, neurologists are in no hurry to reassure, especially with severe hypoxic changes or intrauterine infection. This is due to the variability of the pathology, when it is not possible to predict its outcome in advance. However, there is no need to panic. In some cases, subependymal cysts in newborns resolve on their own by the first year of life or remain forever, without affecting the development of the baby.
Prevention Methods
Is it possible to prevent the appearance of subependymal cyst in newborns? Komarovsky, who is a famous pediatrician, has repeatedly paid attention to this issue. The doctor advises expectant mothers during pregnancy to avoid factors that cause hypoxia in the fetus. For this purpose it is necessary:
- eat balanced;
- prevent infectious processes in the body;
- avoid stress and hypothermia;
- exclude contact with toxic substances;
- visit the gynecologist regularly.
The cyst is a consequence of disturbances in the brain. To eliminate it, it is first necessary to determine the cause of the anomaly. During the ripening period, there is no such possibility. However, in some cases, doctors resort to genetic analysis. It is carried out using amniotic fluid. Such an analysis is advisable only in case of significant suspicion of anomalies in the development of the child inside the womb.