Ependymal cysts are rare benign neuroepithelial cysts lined by ependymal cells. Most are small and asymptomatic and only cause symptoms if large.
They typically present in young adults. There may be a slight male predilection. Patients are often in their 30s at the time of presentation.
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 1. They are most commonly located deep in the parenchyma, although intraventricular, periventricular and subarachnoid space cysts have also been reported 2. Ependymal cysts have been postulated to be the entity responsible for the interhemispheric cysts with the Dandy-Walker malformations and agenesis of the corpus callosum.
On imaging, they are well-defined, thin-walled and do not contrast enhance.
Typically periventricular in location. The cyst is isoattenuating to CSF.
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
- if parenchymal consider
- if intraventricular consider
- intraventricular arachnoid cyst
- asymmetrical ventricles
- choroid plexus cyst: shows restricted diffusion
- subarachnoid space
- 1. Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology. 2006;239 (3): 650-64. doi:10.1148/radiol.2393050823 - Pubmed citation
- 2. Stroustrup smith A, Levine D. Appearance of an interhemispheric cyst associated with agenesis of the corpus callosum. AJNR Am J Neuroradiol. 25 (6): 1037-40. AJNR Am J Neuroradiol (full text) - Pubmed citation