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Minim Invasive Neurosurg 2003; 46(3): 177-181
DOI: 10.1055/s-2003-40732
Case Report
© Georg Thieme Verlag Stuttgart · New York

Giant Cyst of the Cavum Septi Pellucidi, Cavum Vergae and Veli Interpositi

P.  Donati1 , L.  Sardo1 , M.  Sanzo1
  • 1Pediatric Neurosurgical Center, Children's Hospital “A. Meyer”, Florence, Italy
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Publication History

Publication Date:
21 July 2003 (online)

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Abstract

The authors report a case study of a giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi spreading to the posterior fossa, and initially treated elsewhere by ventriculoperitoneal shunt, with no resolution of the symptomatology. A few months later the patient was successfully treated by fenestration into the ventricular system through a neuroendoscopic technique, at the Pediatric Neurosurgical Center of the Meyer Children's Hospital in Florence. Symptomatic midline cysts are quite rare and different techniques have been proposed for their treatment, i. e., direct craniotomy, conventional shunting, stereotactic approaches as well as endoscopic fenestration. In such cases neuroendoscopy obtains a good symptom resolution level, avoiding at the same time the risks of damage to endoventricular structures and often eliminates the need for a definitive ventriculoperitoneal shunt. In the present research the authors analyze the anatomy of the midline cavities and the mechanism through which a cyst may become symptomatic. The surgical endoscopic technique and the clinical and radiological assessments which confirmed the patency of the fenestration are also discussed. The authors conclude that endoscopic ventricular fenestration may represent the treatment of choice for this pathology.

Key words

Neuroendoscopy - midline cavities - intracranial cysts

References

  • 1 Alafaci C, Divitiis O, Salpietro F M, Grasso G, Lucerna S, Cardia E, Gangemi M, Tomasello F. Endoscopic treatment of a symptomatic cyst of the septum pellucidum.  Rivista di Neuroradiologia. 2000;  13 861-866
    PubMedGoogle Scholar
  • 2 Amin B H. Symptomatic cyst of the septum pellucidum.  Childs Nerv Syst. 1986;  2 (6) 320-322
    CrossrefPubMedGoogle Scholar
  • 3 Aoki N. Cyst of the septum pellucidum presenting as hemiparesis.  Childs Nerv Syst. 1986;  2 (6) 326-328
    CrossrefPubMedGoogle Scholar
  • 4 Bayar M A, Gökçek C, Gökçek A, Edebali N, Buharali Z. Giant cyst of the cavum septi pellucidi and cavum Vergae with posterior cranial fossa extension: case report.  Neuroradiology. 1996;  38 187-189
    CrossrefPubMedGoogle Scholar
  • 5 Behrens P, Ostertag C B. Stereotactic management of congenital midline cysts.  Acta Neurochir (Wien). 1993;  123 141-146
    CrossrefPubMedGoogle Scholar
  • 6 Behrens P F, Ostertag C B. Cavum septi pellucidum cysts.  J Neurosurg. 1997;  87 (2) 336-337
    PubMedGoogle Scholar
  • 7 Cohen A R. Endoscopic ventricular surgery.  Pediatr Neurosurg. 1993;  19 127-134
    PubMedGoogle Scholar
  • 8 Cohen A R. Expanding cava septi pellucidi and cava Vergae in children: report of three cases. Correspondence.  Neurosurgery. 1998;  42 674-675
    PubMedGoogle Scholar
  • 9 Dandy W E. Congenital cerebral cysts of cavum septi pellucidi (fifth ventricle) and cavum Vergae (sixth ventricle): diagnosis and treatment.  Arch Neurol Psychiatry. 1931;  25 44-46
    CrossrefPubMedGoogle Scholar
  • 10 Gangemi M, Donati P, Maiuri F. Cyst of the velum interpositum treated by endoscopic fenestration.  Surg Neurol. 1997;  47 134-137
    PubMedGoogle Scholar
  • 11 Gangemi M, Maiuri F, Colella G, Sardo L. Endoscopic surgery for intracranial cerebrospinal fluid cyst malformations.  Neurosurg Focus. 1999;  6 (4): article 6
    PubMedGoogle Scholar
  • 12 Gangemi M, Maiuri F, Donati P, Sigona L. Endoscopic ventricular fenestration of intracranial fluid cysts.  Minim Invas Neurosurg. 1996;  39 7-11
    PubMedGoogle Scholar
  • 13 Garza-Mercado R. Giant cyst of the septum pellucidum. Case report.  J Neurosurg. 1981;  55 646-650
    PubMedGoogle Scholar
  • 14 Jackowski A, Kulshresta M, Sgouros S. Laser-assisted flexible endoscopic fenestration of giant cyst of the septum pellucidum.  Br J Neurosurg. 1995;  9 527-531
    CrossrefPubMedGoogle Scholar
  • 15 Krauss J K, Mohadjier M, Milios E. Image-direct stereotactic drainage of the symptomatic cavum septi pellucidi et Vergae.  Neurochirurgia (Stuttg). 1991;  34 57-61
    PubMedGoogle Scholar
  • 16 Lancon J A, Haines D E, Lewis A I, Parent A D. Endoscopic treatment of symptomatic septum pellucidum cysts: with some preliminary observation on the ultrastructure of the cyst wall: two technical case reports.  Neurosurgery. 1999;  45 1251-1257
    CrossrefPubMedGoogle Scholar
  • 17 Lancon J A, Haines D E, Raila F A, Parent A D, Vedanarayanan V V. Expanding cyst of the septum pellucidum.  J Neurosurg. 1996;  85 1127-1134
    CrossrefPubMedGoogle Scholar
  • 18 Larroche J C, Baudey J. Cavum septi pellucidi, cavum Vergae, cavum veli interpositi: cavities of the median line. Anatomical and pneumoencephalographic study in the neonatal period.  Biol Neonate. 1961;  3 193-236
    PubMedGoogle Scholar
  • 19 Manwaring K H, Hamilton A J. Neurosurgical endoscopy. In: Tindall GT, Cooper PR, Barrow DL (eds): The practice of neurosurgery. Baltimore: Williams & Wilkins 1996: 233-242
    Google Scholar
  • 20 Manwaring K H, Gangemi M. et al . Cyst of the velum interpositum treated by endoscopic fenestration.  Surg Neurol. 1997;  47 137
    PubMedGoogle Scholar
  • 21 Miller M E, Kido D, Horner F. Cavum Vergae: association with neurologic abnormality and diagnosis by magnetic resonance imaging.  Arch Neurol. 1986;  43 821-823
    PubMedGoogle Scholar
  • 22 Ono M, Rhoton A L, Peace D, Rodriguez R J. Microsurgical anatomy of the deep venous system of the brain.  Neurosurgery. 1984;  15 621-657
    CrossrefPubMedGoogle Scholar
  • 23 Oteruelo F T. On the cavum septi pellucidi and the cavum Vergae.  Anat Anz. 1986;  162 (4) 271-278
    PubMedGoogle Scholar
  • 24 Raimondi A J, Choux M, di Rocco C. Intracranial cyst lesions. New York: Springer-Verlag 1993
    Google Scholar
  • 25 Raimondi A J, Gutierrez F E, Jones R R. Cystic cavum veli interpositi associated with normal or low pressure hydrocephalus.  Child Brain. 1975;  1 291-305
    PubMedGoogle Scholar
  • 26 Rossitch Jr E, Wilkins R H. Developmental midline intracranial cysts. In: Wilkins RH, Rengachary SS (eds): Neurosurgery Update II. New York: McGraw-Hill 1991: 298-299
    Google Scholar
  • 27 Scott M. Cysts of the sixth ventricle (cavum Vergae): Successful removal through transventricular approach with notes on embryology and histopathology.  J Neurosurg. 1945;  2 191-201
    PubMedGoogle Scholar
  • 28 Silbert P L, Gubbay S S, Vaughan R J. Cavum septi pellucidum and obstructive hydrocephalus.  J Neurol Neurosurg Psychiatry. 1993;  56 820-822
    CrossrefPubMedGoogle Scholar
  • 29 Teo C, Rahman S, Boop F A, Cherny B. Complications of endoscopic neurosurgery.  Childs Nerv Syst. 1996;  12 248-253
    PubMedGoogle Scholar
  • 30 Van Wagenen W P, Aird R B. Dilatations of the cavity of the septum pellucidum and cavum Vergae: Report of cases.  Am J Cancer. 1934;  20 539-557
    PubMedGoogle Scholar
  • 31 Wester K, Kråkenes J, Moen G. Expanding cava septi pellucidi and cava Vergae in children: report of three cases.  Neurosurgery. 1995;  37 134-137
    CrossrefPubMedGoogle Scholar
  • 32 Wester K, Pedersen P H, Larsen J L, Waaler P E. Dynamic aspects of expanding cava septi pellucidi et Vergae.  Acta Neurochir (Wien). 1990;  104 147-150
    CrossrefPubMedGoogle Scholar
  • 33 Yokota A. Cysts originating from a defect in the hemispheric cleavage (cavum septi pellucidi, cavum Vergae, cavum veli interpositi). In: Raimondi AJ, Choux M, Di Rocco C (eds): Intracranial Cyst Lesions. New York: Springer-Verlag 1993: 87-99
    Google Scholar

Dr. P. Donati

Pediatric Neurosurgical Center · Children's Hospital “A. Meyer”

Via L. Giordano, 13

50132 Firenze · Italy

Phone: +39-055566-2449

Fax: +39-05557-6200