Usefulness of cyst-subarachnoid shunt using syringo-subarachnoid shunt tube for symptomatic enlarging ventriculus terminalis: A case report and review of the literature

Abstract

Background: The ventriculus terminalis (VT) is a cystic embryological remnant of the conus medullaris that usually regresses after birth. This structure rarely persists into adulthood and may produce neurological symptoms. We recently encountered three cases of symptomatic enlarging VT. Case Description: The three female patients were 78, 64, and 67 years old. Symptoms included pain, numbness, motor weakness, and frequent urination that gradually worsened. Magnetic resonance imaging revealed cystic dilatations of slow growing VT. These patients showed marked improvement after cyst-subarachnoid shunt using a syringo-subarachnoid shunt tube. Conclusion: Symptomatic enlarging VT is an extremely rare cause of conus medullaris syndrome and the optimal treatment strategy remains unclear. Surgical management may thus be appropriate for patients with symptomatic enlarging VT.

Cystic dilatation of the ventriculus terminalis: A narrative review

“…The present investigation examined the prevalence of various preoperative MRI abnormalities, the extent of spinal segment involvement, the dimensions of cysts, and associated abnormalities such as tethered cord, dysraphism, and lipoma. [ 3 4 5 , 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 ] The findings underscore the importance of preoperative MRI in understanding the characteristics of VTs and their potential impact on neighboring anatomical structures. There was considerable diversity seen in the distribution of cysts across different spinal segments.…”

“…In total, 290 articles were found after an initial search of the PubMed, Scopus, and Google Scholar databases. In total, 34 studies[ 3 4 5 , 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 ] met the inclusion criteria after being screened for quality via titles, abstracts, and full texts. The present study involved the analysis of patient-level data from a cohort of 90 individuals presenting with ventricularis terminalis.…”

“…The results suggest that individuals with VTs display a wide range of ages, including both newborns[ 1 , 26 , 37 ] and elderly individuals. [ 3 , 5 , 35 ] The observed mean ages in the several studies displayed diversity, which can be related to the varying frequency of the condition among different age groups. Several studies have shown a propensity for a greater number of females,[ 3 , 4 , 9 , 11 , 22 , 32 , 34 ] while others have indicated a virtually equal distribution of both genders.…”

“…Some individuals may not show any noticeable signs, while others may experience symptoms such as lower back pain, reduced strength or sensation in the legs, difficulties with walking or maintaining posture, loss of control over urine or feces, and poor sexual function. [ 5 , 6 ] MRI is the gold standard for diagnosing VT because it clearly displays the characteristic appearance of a hollow filled with fluid inside the conus medullaris. The differential diagnosis includes additional cystic lesions that might impact the spinal cord, such as syringomyelia, arachnoid cysts, or malignancies.…”

“…There is a lack of cohesion in the existing literature, which is primarily comprised of case reports. [ 1 2 3 4 5 6 ] Through a thorough examination of the available studies, the primary objective of this literature review is to offer a comprehensive comprehension of the anatomical variability, diagnostic methods, symptomatic manifestations, and diverse surgical techniques employed in individuals with VT.…”