Download PDF
Minim Invasive Neurosurg 2003; 46(4): 243-249
DOI: 10.1055/s-2003-42351
Case Report
© Georg Thieme Verlag Stuttgart · New York

Symptomatic Cysts of the Cavum Septi Pellucidi and Cavum Vergae: The Role of Endoscopic Neurosurgery in the Treatment of Four Consecutive Cases

M.  Fratzoglou1 , P.  Grunert2 , A.  Leite dos Santos2 , P.  Hwang2 , G.  Fries2
  • 1Department of Neurosurgery, Medical School, University of Patras, Greece
  • 2Department of Neurosurgery, Medical School, University of Mainz, Germany
Further Information

Publication History

Publication Date:
24 September 2003 (online)

    Permissions and Reprints

Abstract

Cavum septi pellucidi and cavum vergae are generally asymptomatic fluid collections between the leaves of the septum pellucidum and are present in approximately 15 % of adult brains. These cavities rarely enlarge and become symptomatic causing significant neurological dysfunction as a result of obstruction of the interventricular foramina, distortion of the vascular structures of the deep venous system or compression of the hypothalamoseptal triangle. The authors present a series of four patients with symptoms related directly to pressure effects from the cyst wall to the neighbouring deep brain structures. There were two females and two males with a mean age of 47.5 years. All four patients underwent endoscopic cyst fenestration with a rigid endoscope. In 2 patients frameless neuronavigation was accomplished with the optical tracking system (Radionics, Burlington, USA). All symptoms related to pressure effect resolved after surgery. Endoscopic pellucidotomy of symptomatic cysts of the septum pellucidum produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Additionally, frameless neuronavigation is a useful tool in planning and realizing the approach and improving intraoperative orientation.

Key words

Endoscopic neurosurgery - neuronavigation - septum pellucidum cyst - cavum septi pellucidi - cavum vergae - cerebral cysts

References

  • 1 Aldur M M, Gürcan F, Basar R, Aksit M D. Frequency of septum pellucidum anomalies in non-psychotic population: a magnetic resonance imaging study.  Surgical Radiologic Anatomy. 1999;  21 119-123
    PubMedGoogle Scholar
  • 2 Amin B H. Symptomatic cysts of the septum pellucidum.  Childs Nerv Syst. 1986;  2 320-322
    CrossrefPubMedGoogle Scholar
  • 3 Aoki N. Cyst of the septum pellucidum presenting as hemiparesis.  Childs Nerv Syst. 1986;  2 326-328
    CrossrefPubMedGoogle Scholar
  • 4 Bayar M A, Gokcek C, Gokcek 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 (Suppl 1) 187-189
    CrossrefPubMedGoogle Scholar
  • 5 Behrens P F, Ostertag C B. Cavum septum pellucidum cysts.  J Neurosurg. 1997;  87 336-337
    PubMedGoogle Scholar
  • 6 Bogdanoff B, Natter H. Incidence of cavum septum pellucidum in adults: A sign of boxer's encephalopathy.  Neurology. 1989;  39 991-992
    CrossrefPubMedGoogle Scholar
  • 7 Butt W, Havill D, Daneman A, Pape K. Hemorrhage and cyst development in the cavum septi pellucidi and cavum vergae. Report of three cases.  Pediatr Radiol. 1985;  15 368-371
    PubMedGoogle Scholar
  • 8 Caemaert J, Abdullah J, Calliaw L, Carton D, Dhooge C, Coster R van. Endoscopic treatment of suprasellar arachnoid cysts.  Acta Neurochirurgica. 1992;  119 68-73
    CrossrefPubMedGoogle Scholar
  • 9 Chen C J. Expanding septum pellucidum cyst due to a traumatic ventriculoperitoneal shunt.  Neuroradiology. 1999;  41 567-569
    CrossrefPubMedGoogle Scholar
  • 10 Ciric I, Zivin I. Neuroepitheliai (colloid) cysts of the septum pellucidum.  J Neurosurg. 1975;  43 69-73
    PubMedGoogle Scholar
  • 11 Cohen A R. Expanding cava septi pellucidi and cava vergae in children: Report of three cases.  Neurosurgery. 1998;  42 674-675
    PubMedGoogle Scholar
  • 12 Cowley A R, Moody D M, Alexander Jr E, Ball M R. CT appearance of cyst of the cavum septi pellucidi.  AJR Am J Roentgenol. 1979;  133 548-550
    PubMedGoogle Scholar
  • 13 Dandy W E. Congenital cerebral cysts of cavum septi pellucidi (fifth ventricle) and cavum vergae (sixth ventricle).  Arch Neurol Psychiatry. 1931;  15 44-66
    PubMedGoogle Scholar
  • 14 Dublin A B, French B N. Cysticercotic cyst of the septum pellucidum.  AJNR Am J Neuroradiol. 1980;  1 205-206
    PubMedGoogle Scholar
  • 15 Gangemi M, Maiuri F, Cappabianca P, Alafaci C, Divitiis O de, Tomasello F, Divitiis E de. Endoscopic fenestration of symptomatic septum pellucidum cysts: Three case reports with discussion on the approaches and technique.  Minim Invasive Neurosurg. 2002;  45 105-108
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Garza-Mercado R. Giant cyst of the septum pellucidum: Case report.  J Neurosurg. 1981;  55 646-650
    PubMedGoogle Scholar
  • 17 Grunert P, Müller-Forell W, Darabi K, Reisch R, Busert C, Hopf N, Perneczky A. Basic principles and clinical applications of neuronavigation and intraoperative computed tomography.  Computer Aided Surgery. 1998;  3 166-173
    CrossrefPubMedGoogle Scholar
  • 18 Grunert P, Espinosa J, Busert C, Günther M, Filippi R, Farag S, Hopf N. Stereotactic biopsies guided by an optical navigation system: Technique and clinical experience.  Minim Invasive Neurosurg. 2002;  45 11-15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Gubbay S S, Vaughan R, Lekias J S. Intermittent hydrocephalus due to cysts of the septum pellucidum: A study of three cases.  Clin Exp Neurol. 1977;  14 93-99
    PubMedGoogle Scholar
  • 20 Heiskanen O. Cyst of the septum pellucidum causing increased intracranial pressure and hydrocephalus. Case report.  J Neurosurg. 1973;  38 771-773
    PubMedGoogle Scholar
  • 21 Hopf N J, Grunert P, Darabi K, Busert C, Bettag M. Frameless neuronavigation applied to endoscopic neurosurgery.  Minim Invasive Neurosurg. 1999;  42 187-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 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
  • 23 Jackowski A. Endoscopic fenestration of a symptomatic cyst of the septum pellucidum.  Br J Neurosurg. 2001;  15 286
    PubMedGoogle Scholar
  • 24 Kocer N, Kantarci F, Mihmalli I, Islak C, Cokyuksel O. Spontaneous regression of a cyst of the cavum septi pellucidi.  Neuroradiology.. 2000;  5 360-362
    PubMedGoogle Scholar
  • 25 Krauss J K, Mohadjer M, Milios E, Scheremet R, Mundinger F. Image-directed stereotactic drainage of the symptomatic cavum septi pellucidi et vergae.  Neurochirurgia (Stuttg.). 1991;  34 57-71
    PubMedGoogle Scholar
  • 26 Krauss J K, Mundinger F. Cavum septum pellucidum cysts.  J Neurosurg. 1997;  87 337-338
    PubMedGoogle Scholar
  • 27 Lancon J A, Haines D E, Raila F A, Parent A D, Vedanarayanan V. Expanding cyst of the septum pellucidum. Case report.  J Neurosurg. 1996;  85 1127-1134
    CrossrefPubMedGoogle Scholar
  • 28 Lancon J A, Haines D E, Lewis A I, Parent A D. Endoscopic treatment of symptomatic septum pellucidum cysts: With some preliminary observations on the ultra structure of the cyst wall: Two technical case reports.  Neurosurgery. 1999;  45 1251-1257
    CrossrefPubMedGoogle Scholar
  • 29 Lewis S W, Mezey G C. Clinical correlates of septum pellucidum cavities: An unusual association with psychosis.  Psychol Med. 1985;  15 43-54
    CrossrefPubMedGoogle Scholar
  • 30 Mapstone T B, White R J. Cavum septi pellucidi as a cause of shunt dysfunction.  Surg Neurol. 1981;  16 96-98
    PubMedGoogle Scholar
  • 31 Mishra G P, Sharma R R, Musa M M, Pawar S J. Endodermal cyst of septum pellucidum and pregnancy: A case report.  Surg Neurol. 2000;  53 583-585
    PubMedGoogle Scholar
  • 32 Miyamori T, Miyamori K, Hasegawa T, Tokuda K, Yamamoto Y. Expanded cavum septi pellucidi and cavum vergae associated with behavioural symptoms relieved by a stereotactic procedure: Case report.  Surg Neurol. 1995;  44 471-475
    CrossrefPubMedGoogle Scholar
  • 33 Pierfrancesco M, Stefania F, Carmelo M, Umberto G. Symptomatic cyst of the septum pellucidum treated by stereotactic intraventricular drainage.  Stereotact Funct Neurosurgery. 1995;  64 134-138
    PubMedGoogle Scholar
  • 34 Ronsin E, Grosskopf D, Perre J. Morphology and immunohistochemistry of a symptomatic septum pellucidum cavum vergae cyst in man.  Acta Neurochir (Wien). 1997;  139 366-371
    CrossrefPubMedGoogle Scholar
  • 35 Sarwar M. The septum pellucidum: Normal and abnormal.  AJNR Am J Neuroradiol. 1989;  10 989-1005
    PubMedGoogle Scholar
  • 36 Sauter R, Klemm T, Hassler W. Growing septum pellucidum cyst in infancy.  Klin Pädiatr. 1995;  207 122-125
    PubMedGoogle Scholar
  • 37 Sener R N. Cysts of the septum pellucidum.  Comput Med Imaging Graph. 1995;  19 357-360
    PubMedGoogle Scholar
  • 38 Shaw C M, Alvord Jr E C. Cava septi pellucidi et vergae: Their normal and pathological stage.  Brain. 1969;  92 213-224
    CrossrefPubMedGoogle Scholar
  • 39 Silbert P L, Gubbay S S, Vaughan R J. Cavum septum pellucidum and obstructive hydrocephalus.  J Neurol Neurosurg Psychiatry. 1993;  56 820-822
    CrossrefPubMedGoogle Scholar
  • 40 Stappenbeck L, Moller W D. Diagnosis and clinical aspects of the noncommunicating cavity of the septum pellucidum.  Radiologe. 1973;  13 512-514
    PubMedGoogle Scholar
  • 41 Wagenen W P van, 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
  • 42 Vaquero J, Manrique M, Prado F de. Endoscopic fenestration of a symptomatic cyst of the septum pellucidum.  Br J Neurosurg. 2000;  14 560-562
    CrossrefPubMedGoogle Scholar
  • 43 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
  • 44 Wester K, Krakenes J, Moen G. Expanding cava septi pellucidi and cava Vergae in children: Report of three cases.  Neurosurgery. 1995;  37 134-137
    CrossrefPubMedGoogle Scholar
  • 45 Wilson C B, Howieson J. Cysts of the septum pellucidum. Review and report of one case.  Neurochirurgia (Stuttg.). 1970;  13 93-99
    PubMedGoogle Scholar

M. Fratzoglou, M. D. 

Department of Neurosurgery · Medical School, University of Patras

26500 Patras

Greece

Phone: +30-610-999752

Phone: +30-102-022208

Fax: +30-610-991574

Email: akisfratzoglou@hotmail.com

      >