Endoscopic Treatment of Symptomatic Septum Pellucidum Cysts: With Some Preliminary Observations on the Ultrastructure of the Cyst Wall: Two Technical Case Reports

Endoscopic Treatment of Symptomatic Septum Pellucidum Cysts: With Some Preliminary Observations... AbstractOBJECTIVE AND IMPORTANCE:We describe two patients with symptomatic septum pellucidum cysts managed by endoscopic fenestration. In each case, tissue from the cyst wall was studied to define the origin of the cyst wall and fluid.CLINICAL PRESENTATION:The patients, a 6-year-old boy and a 42-year-old man, each presented with headaches and a syncopal episode. Imaging studies demonstrated large septum pellucidum cysts with obstruction of the foramina of Monro.INTERVENTION:The patients underwent endoscopic transventricular cyst fenestration with a 4-mm steerable fiberscope. The fenestrations were created to allow communication with the right and left lateral ventricles. In one patient, adhesions between the cyst wall and the foramen of Monro were lysed with endoscopic monopolar cautery. Tissue from the cyst walls was removed for examination by electron microscopy. Postoperatively, the headaches and syncopal episodes resolved in both patients.CONCLUSION:Endoscopic fenestration of symptomatic septum pellucidum cysts produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Cannulation of the lateral ventricle before cyst fenestration prevents inadvertent injury to the fornices, thalamus, internal capsule, caudate nucleus, and septal and thalamostriate veins. The endoscopic approach allows the surgeon to ensure communication within the ventricular system, thus avoiding placement of a shunt. Preliminary ultrastructural analysis indicates that the cyst walls derive from the septum pellucidum rather than the choroid plexus or arachnoid. The cellular machinery necessary for fluid secretion was identified in some specimens. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Endoscopic Treatment of Symptomatic Septum Pellucidum Cysts: With Some Preliminary Observations on the Ultrastructure of the Cyst Wall: Two Technical Case Reports

Endoscopic Treatment of Symptomatic Septum Pellucidum Cysts: With Some Preliminary Observations on the Ultrastructure of the Cyst Wall: Two Technical Case Reports

junction of the rostrum with the genu of Endoscopic Treatment of Symptomatic the corpus callosum (the commissuro- callosal line), and a line extending cau- Septum Pellucidum Cysts: With Some doventrally back to the optic chiasm (17). As a consequence of the many im­ Preliminary Observations on the portant anatomic structures lying within or immediately adjacent to this Ultrastructure of the Cyst W all: Two triangle, the clinical presentation of a sym ptom atic septum pellucidum cyst Technical Case Reports varies. Visual, behavioral, autonomic, and sensorimotor disturbances m ay be present ( 3 , 1 3 , 1 4 , 1 7 , 20, 23, 27, 29, 37). A bimodal age of presentation has been J o h n A . L a n c o n , M . D . , D u a n e E. H a i n e s , P h . D . , described (17). Interestingly, some ex­ A d a m I. L e w i s , M . D . , A n d r e w D . P a r e n t , M . D . panding cysts remain asym ptom atic de­ Departments of Neurosurgery (JAL, DEH, AIL, ADP) and Anatomy (DEH), University of spite radiological evidence of mass ef­ Mississippi Medical Center, Jackson, Mississippi fect (17, 34-3 6 ). The primary goal of surgical interven­ tion is to relieve the mass effect caused by the cyst. In each case, a decision to O BJECTIVE A N D IM P O R T A N C E : W e describe two patients with symptom­ intervene surgically must be m ade on atic septum pellucidum cysts managed by endoscopic fenestration. In the basis of correlation of the clinical each case, tissue from the cyst w all was studied to define the origin of the signs and sym ptom s with the imaging cyst wall and fluid. studies (17). We present our experience CLINICAL P R E S E N T A T IO N : The patients, a 6-year-old boy and a 42-year-old with the endoscopic fenestration of two man, each presented w ith headaches and a syncopal episode. Imaging symptomatic septum pellucidum cysts studies demonstrated large septum pellucidum cysts with obstruction of and describe the endoscopic anatom y and technique. In...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199911000-00055
Publisher site
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Abstract

AbstractOBJECTIVE AND IMPORTANCE:We describe two patients with symptomatic septum pellucidum cysts managed by endoscopic fenestration. In each case, tissue from the cyst wall was studied to define the origin of the cyst wall and fluid.CLINICAL PRESENTATION:The patients, a 6-year-old boy and a 42-year-old man, each presented with headaches and a syncopal episode. Imaging studies demonstrated large septum pellucidum cysts with obstruction of the foramina of Monro.INTERVENTION:The patients underwent endoscopic transventricular cyst fenestration with a 4-mm steerable fiberscope. The fenestrations were created to allow communication with the right and left lateral ventricles. In one patient, adhesions between the cyst wall and the foramen of Monro were lysed with endoscopic monopolar cautery. Tissue from the cyst walls was removed for examination by electron microscopy. Postoperatively, the headaches and syncopal episodes resolved in both patients.CONCLUSION:Endoscopic fenestration of symptomatic septum pellucidum cysts produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Cannulation of the lateral ventricle before cyst fenestration prevents inadvertent injury to the fornices, thalamus, internal capsule, caudate nucleus, and septal and thalamostriate veins. The endoscopic approach allows the surgeon to ensure communication within the ventricular system, thus avoiding placement of a shunt. Preliminary ultrastructural analysis indicates that the cyst walls derive from the septum pellucidum rather than the choroid plexus or arachnoid. The cellular machinery necessary for fluid secretion was identified in some specimens.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1999

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