An Analysis of Outcome of Endoscopic Fenestration of Cavum Septum Pellucidum Cyst - More Grey than Black and White?

Abstract

Background: Cavum septum pellucidum (CSP) and cavum vergae are actually fluid-filled, generally communicating midline cavities located between the third ventricle and corpus callosum. There have been various reports of their association with many behavioral and psychiatric disorders. Infrequently, they have been associated with an obstructive hydrocephalus-like picture. Although the structure and management of CSP has long been known, it has been an enigma as far as functional significance and management indications are concerned. The authors of this article try to analyze the significance of a persistent cavum and involvement of the same entity in varied presentations ranging from an incidental imaging finding to acute hydrocephalus, and propose a possible implication on the present surgical intervention paradigm. Purpose: To assess the surgical outcome of fenestration of a CSP cyst. Methods: Retrospective analysis of 3 patients who underwent endoscopic fenestration for CSP with obstructive hydrocephalus between 2012 and 2014 was done, and data were analyzed for symptomatic clinical improvement in particular behavior. Results: Pre- and postoperative brain MRI showed a significant decrease in the size of the cyst as well as the ventricles. There were no recurrences during follow-up. All of the patients improved. Conclusions: (1) Endoscopic fenestration of symptomatic CSP cysts is a safe treatment option. (2) Neurocognitive assessment is essential in the evaluation and outcome assessment of CSP.

Surgical management of symptomatic cavum septum pellucidum cysts: systematic review of the literature

“…Moreover, most of the cases reported in the literature presented with radiological evidence of hydrocephalus, as well as regression of the cyst on postoperative imaging 1-[31]. Regarding the size of the cyst, several authors argue that a CSP is defined as a cyst having a width of 10 mm or more between the ventricles [1][2][3][4][5][19][20][21][22][23][24][25]. It may not be reasonable to consider a surgical fenestration for smaller cysts.…”

“…Interestingly, psychiatric symptoms, mainly behavioral disturbances, were the second most common finding (56%). We use the generic term "psychiatric symptoms," because of the heterogeneity of symptoms reported in the literature: behavioral changes, eating disorder, mood disturbances, and anxiety have been reported by several authors [1,3,[5][6][7][8][9][10]. These symptoms may be difficult to correlate with CSP and CV cysts.…”

“…Absence of hydrocephalus at presentation may suggest that the correlation between the cyst and the presenting symptoms is unclear. Conservative management could be offered in those cases, although some reports suggest that symptoms may be improved [1,3,5,6]. Most of the papers reviewed did not specify the duration of symptoms for each patient.…”

“…It is anatomically distinct from cavum vergae (CV) which is a CSF space extending posteriorly to the columns of the fornix. However, CSP and CV cysts are used interchangeably in the literature and may coexist in many cases [1][2][3][4][5]. In this manuscript, we will use the terminology cavum septum pellucidum and vergae (CSP and CV) cyst.…”

“…In this manuscript, we will use the terminology cavum septum pellucidum and vergae (CSP and CV) cyst. Although considered as an incidental finding by most neurosurgeons, they may present with symptoms related to hydrocephalus, like headaches, nausea or vomiting, loss of consciousness, or psychiatric disturbances [1][2][3][4][5][6][7][8][9][10]. There is no consensus about the management of symptomatic CSP and CV cysts, and various procedures (endoscopic or stereotactic fenestration, shunting, open fenestration, etc.)…”