Ependymal cyst [Neurosurgery Wiki]

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====== Ependymal cyst ======

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Ependymal [[cyst]]s are rare benign [[neuroepithelial cyst]]s lined by [[ependymal cell]]s. Most are small and asymptomatic and only cause symptoms if large.
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A glioependymal cyst and an [[ependymal cyst]] are the same things. They are both terms used to describe a cyst that originates from [[ependyma]]l cells, which are specialized cells that line the [[ventricle]]s of the brain and the central canal of the spinal cord. These cysts are typically benign and can occur in various locations within the central nervous system. The terms "glioependymal cyst" and "ependymal cyst" are used interchangeably to refer to this type of cyst.

On the other hand, a [[neuroglial cyst]], also referred to as a [[glia]]l [[cyst]] or an astroglial cyst, is a type of cyst that contains a fluid-filled cavity lined by [[glia]]l cells, which are supportive cells of the nervous system. Neuroglial cysts can occur in various locations within the brain or spinal cord, and their size and symptoms can vary depending on the specific location and characteristics of the cyst.

While both types of cysts involve glial cells and can occur in the central nervous system, glioependymal cysts specifically involve ependymal cells, whereas neuroglial cysts can involve different types of glial cells such as astrocytes. Therefore, they are distinct entities with some differences in their origin and characteristics.
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On imaging, these cysts are essentially indistinguishable from other intraventricular simple cysts (e.g. [[intraventricular arachnoid cyst]]s).

====Epidemiology====

They typically present in young adults. There may be a slight male predilection. Patients are often in their 30s at the time of presentation.

====Pathology====

It is thought to arise from sequestration of developing [[neuroectoderm]] during embryogenesis. They are thin-walled and contain clear serous fluid secreted by the lining [[ependyma]].

They are most commonly located deep in the parenchyma, although intraventricular, periventricular and subarachnoid space cysts have also been reported.

[[Ependymal cyst]]s have been postulated to be the entity responsible for the [[interhemispheric cyst]]s with the [[Dandy Walker malformation]]s and agenesis of the corpus callosum.


====Markers====
GFAP and S100 markers are often positive due to its neuroepithelial lining.

====Radiographic features====

On imaging, they are well-defined, thin-walled and do not contrast enhance.  

===CT===
Typically periventricular in location. The cyst is isoattenuating to CSF.  

===MRI===
Follows CSF signal on all sequences and does not demonstrate diffusion restriction. Occasionally the cyst may be hyperintense to CSF if there is a high protein content. No contrast enhancement.

====Treatment and prognosis====

Asymptomatic cysts may be monitored. In surgically resected cases recurrence is extremely rare and the prognosis is excellent. 

Large cysts in vulnerable locations may cause obstructive hydrocephalus

====Differential diagnosis====

if parenchymal consider

perivascular cyst

neurocysticercosis

porencephalic cyst

if intraventricular consider

intraventricular arachnoid cyst

asymmetrical ventricles

choroid plexus cyst: shows restricted diffusion

subarachnoid space

arachnoid cyst

epidermoid cyst

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Noncommunicating interhemispheric [[cyst]]s, such as [[interhemispheric arachnoid cyst]] or [[ependymal cyst]], with callosal agenesis are also in the second category. A careful review of embryologic development is essential for understanding these midline cysts and for making a more accurate radiologic diagnosis
((Utsunomiya H, Yamashita S, Takano K, Ueda Y, Fujii A. Midline cystic
malformations of the brain: imaging diagnosis and classification based on
embryologic analysis. Radiat Med. 2006 Jul;24(6):471-81. Review. PubMed PMID:
16958432.
)).

==== Lateral ventricular ependymal cyst ====
[[Lateral ventricular ependymal cyst]]

===== Ependymal cyst endoscopic fenestration =====
[[Ependymal cyst endoscopic fenestration]]