Neuroendoscopic Management of Symptomatic Septum Pellucidum Cavum Vergae Cyst Using a High-Definition Flexible Endoscopic System -Case Report-

Abstract

A 24-year-old man, who had an asymptomatic septum pellucidum cyst incidentally found one year previously, presented with severe headache and right abducens nerve palsy caused by expansion of the midline cyst. Preoperative magnetic resonance (MR) imaging revealed obstructive hydrocephalus due to the enlarged midline cyst. Neuroendoscopic fenestration of the septum pellucidum cyst was successfully performed via a right frontal approach using a high-resolution flexible neuroendoscopic system without complication. Communication between the cyst cavity and bilateral lateral ventricles was constructed via a single trajectory. The entire inner cyst wall could be inspected from the cyst cavity by manipulating the flexible neuroendoscopic system, which excluded the presence of neoplasm. His symptoms were completely relieved after surgery, and postoperative MR imaging showed significant improvement of hydrocephalus and shrinkage of the midline cyst. Septum pellucidum cavum vergae cyst may expand and become symptomatic, so fenestration using a flexible neuroendoscope system may be the optimal method for constructing communication to the bilateral lateral ventricles with minimal invasion.

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

“…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.…”

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

“…We successfully implemented high-definition camera-on-a-chip flexible endoscopy during the course of combined ETV and lesion biopsy in order to effectively visualize and complete the surgical task. High definition flexible endoscopy has been reported once previously for management of a septum pellucidum cyst, but the case described here demonstrates the first application of the camera-on-a-chip HD technology for accessing the third ventricle and a periaqueductal lesion (12). The case displays the evolving capacity of high-definition flexible endoscopy to expand neuroendoscopic access to complex intraventricular and periventricular lesions.…”

A flexible endoscope-assisted interhemispheric transcallosal approach through the contralateral ventricle for the removal of a third ventricle craniopharyngioma: A technical report

“…[ 19 ] Recently, a high-definition flexible endoscope was described that provided clear and wide vision and contributed significantly to safer surgical procedures. [ 8 15 ]…”