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. 2020 Apr 15;60(4):202-208.
doi: 10.2176/nmc.oa.2019-0001. Epub 2020 Mar 5.

Expanding Cyst of the Septum Pellucidum - Endoscopic Observations on the Mechanism of Development and Results of Treatment

Leszek Sagan  1 , Bartosz Limanówka  1 , Leszek Herbowski  2 , Wojciech Poncyljusz  3 , Maria Giżewska  4
Affiliations

Expanding Cyst of the Septum Pellucidum - Endoscopic Observations on the Mechanism of Development and Results of Treatment

Leszek Sagan et al. Neurol Med Chir (Tokyo). .

Abstract

Cysts of the septum pellucidum (CSP) are usually asymptomatic; however, in some cases they can begin expanding and cause neurological deterioration. The mechanism leading to the formation of an expanding cyst of the septum pellucidum (ECSP) is not known. Based on observations made during endoscopic treatment of ECSP we analyzed intraoperative findings in respect to cyst formation mechanism and treatment prognosis. A group of 31 patients was studied. Only cases with bulging cyst walls occupying the frontal horns observed on imaging studies were included. The main symptom was a severe, intermittent headache. In three cases short term memory deficits were diagnosed. In one case papilloedema was observed. All patients underwent endoscopic fenestration of the ECSP. There were no cases of cyst reocclusion during a follow-up period of 1-14 years (mean 6.2 years). In 30 cases headaches resolved completely and in one case its intensity was significantly smaller. There was one case of postoperative hemiparesis. In all but two cases the thin, translucent region in the anterior part of the cyst floor was found. In the region small fissures and in three cases choroid plexus were observed. Endoscopic fenestration is the efficient treatment for ECSP. ECSP is formed on the basis of not completely closed, developmental communication of the cyst with other fluid spaces. The communication is opened by transient elevation of intraventricular pressure, and acts as a valve leading to fluid accumulation among the walls of the previously asymptomatic cavum septum pellucidum.

Keywords: cyst; neuroendoscopy; septum pellucidum.

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Conflict of interest statement

Conflicts of Interest Disclosure

The authors declare that they have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Endoscopic view of the frontal horn of the right lateral ventricle before ECSP fenestration. The frontal horn of the lateral ventricle and lumen of the foramen of Monro are narrowed by bulging wall of the ECSP. ECSP, expanding cyst of septum pellucidum.
Fig. 2.
Fig. 2.
Endoscopic view of the membranous area at the anterior part of the ECSP floor. Slit among layers of the membrane with the uncovered blood vessel coming through the opening-valve apparatus. ECSP, expanding cyst of septum pellucidum.
Fig. 3.
Fig. 3.
View of the third ventricle through the fenesration of the membrane in the cyst floor.
Fig. 4.
Fig. 4.
Preoperative MR image showing distended walls of the ECSP narrowing the lower aspect of the frontal horns and CSF space continuation between the ECSP and the region of lamina terminals cistern (arrow). ECSP, expanding cyst of septum pellucidum.
Fig. 5.
Fig. 5.
Before endoscopic fenestration the cyst’s bulging walls hung down over the foramen of Monro and rest against the head of the caudate nuclei as a sign of increased inner pressure significantly narrowing the posterior part of the frontal horns (A). Postoperative CT image demonstrating relaxed, parallel walls of the cyst (B).
See this image and copyright information in PMC

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