1
|
Rafka HE, Shaw ES, Saway BF, Slade D, Kelly TH, Eskandari R. Management of Pediatric Cavum Cysts: A Scoping Review and a Single Institution Case Series. Pediatr Neurosurg 2024:1-9. [PMID: 38688244 DOI: 10.1159/000538837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Pediatric cavum cysts are a rare yet complicated pathology to manage. The literature is scarce, primarily consisting of case series, and lacking a consensus regarding clear management. In this scoping review, we aimed to compile existing information in the literature regarding the management of pediatric cavum cysts across the last 10 years. We also present our management of 19 patients, the largest case series to date, highlighting knowledge gaps surrounding the management of this salient pathology. METHODS A literature search using PubMed and SCOPUS was conducted using the following search terms: (pediatric) AND (Cavum septum pellucidum) OR (cavum vergae) OR (cavum velum interpositum) AND (management). Eligibility criteria included peer-reviewed publication published in the last 10 years, pediatric population, cavum cyst, and English language. A retrospective search was conducted for all pediatric cavum cysts between 2013 and 2023 at our institution. Clinical and radiographic characteristics as well as intervention and outcome data were collected for both the scoping review and our cases. RESULTS 330 total articles were populated using our search. 12 articles met our inclusion criteria. 41.7% (n = 5) of the articles were case series, 33.3% (n = 4) were case reports, 8.3% (n = 1) was a technical article, 8.3% (n = 1) was a systematic review, and 8.3% (n = 1) was a case questionnaire. Resolution of symptoms was noted in all articles of our scoping review, regardless of treatment modality. The average age in our case series was 9.84 years old and average age at diagnosis was 5.53 years old. 6 patients (31.6%) were female and 13 patients (68.4%) were male. 2 out of the 19 patients (10.5%) were surgically treated. CONCLUSION There is no clear consensus on the management of cavum cysts. A prospective, multicenter study is needed to create standardized pediatric cyst management guidelines. The current thought is that surgical intervention should be saved for those patients with obstructive hydrocephalus and signs of intracranial hypertension.
Collapse
Affiliation(s)
- Habib Emil Rafka
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA,
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA,
| | - Eric Scot Shaw
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Fabian Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Slade
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas Harold Kelly
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ramin Eskandari
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
2
|
Krejčí T, Krejčí O, Lipina R. Spontaneous Regression of a Symptomatic Cyst of the Cavum Septi Pellucidi and Vergae. J Neurol Surg A Cent Eur Neurosurg 2023; 84:606-609. [PMID: 35062033 DOI: 10.1055/a-1747-9816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Spontaneous regression of cysts of the cavum septi pellucidi (CSP) and cavum vergae (CV) is rare and little discussed. The authors present their case report of this phenomenon following a severe headache in a 23-year-old woman, in whom magnetic resonance imaging (MRI) had previously confirmed significant thinning of the left lateral cyst wall. We consider this finding to be a possible predisposing factor to rupture and the spontaneous regression of such cysts. In addition to the mechanism of cyst regression, the interrelated causes of their expansion and formation will be discussed.
Collapse
Affiliation(s)
- Tomáš Krejčí
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ondřej Krejčí
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| |
Collapse
|
3
|
IKEDA N, TAMURA Y, MATSUSHITA Y, KANEMITSU T, NONOGUCHI N, FURUSE M, KAWABATA S, TAKAMI T, KUROIWA T, WANIBUCHI M. Characteristic and Management of Symptomatic Septum Pellucidum Cyst in Extreme Elderly Patient: Case Report and Literature Review. NMC Case Rep J 2022; 9:19-23. [PMID: 35340330 PMCID: PMC8906833 DOI: 10.2176/jns-nmc.2021-0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Septum pellucidum cyst is rare and is defined as a fluid-filled space between the lateral ventricles; it has a width of 10 mm or more. In this case report, a surgical patient of symptomatic septum pellucidum cyst (SPC) in extreme age is described. To the best our knowledge, this is the first report of an extremely aged patient with symptomatic SPC that was successfully treated using a flexible neuroendoscope. An 85-year-old male complained of gradually worsening gait disturbance, dementia, and urinary incontinence without headache and was admitted to our hospital. MRI revealed a huge cyst between the lateral ventricles as well as ventricle dilatation with periventricular hyperintensity in T2-weighted image. The patient was diagnosed with symptomatic hydrocephalus with SPC and underwent neuroendoscopic fenestration of the cyst with the use of a flexible endoscope without cerebrospinal fluid shunt placement. Immediately after the surgery, the patient's gait disturbance and dementia were dramatically improved. In extremely aged patients, SPC tended to develop with idiopathic normal pressure hydrocephalus-like symptoms, including gait disturbance without increasing intracranial pressure, sensorimotor disturbances, and psychological disorders. Neuroendoscopic cyst fenestration with the use of a flexible scope for SPC is a less-invasive procedure and should be considered even for extreme elderly symptomatic patients.
Collapse
Affiliation(s)
- Naokado IKEDA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Yoji TAMURA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Yoko MATSUSHITA
- Department of Neurosurgery, Tesseikai Neurosurgical Hospital
| | - Takuya KANEMITSU
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Naosuke NONOGUCHI
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Motomasa FURUSE
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Shinji KAWABATA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Toshihiro TAKAMI
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Toshihiko KUROIWA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Masahiko WANIBUCHI
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| |
Collapse
|
4
|
Tosi U, Uribe-Cardenas R, Lara-Reyna J, Villamater FN, Perera I, Stieg PE, Tsiouris AJ, Souweidane MM. Transseptal interforniceal endoscopic removal of superiorly recessed colloid cysts. J Neurosurg 2022; 137:813-819. [PMID: 35090131 DOI: 10.3171/2021.11.jns211754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Transforaminal endoscopic colloid cyst resection is well described. However, some anatomical colloid cyst variants may warrant a modified approach. Rarely, colloid cysts separate the forniceal columns and grow superiorly within the leaflets of the septum pellucidum. Thus, the authors' goal was to characterize the imaging features, clinical presentation, surgical strategy, and outcomes of patients with this superiorly recessed colloid cyst variant. METHODS A retrospective evaluation of patients who underwent endoscopic resection of colloid cysts from 1999 to 2020 was performed. The patients were dichotomized depending on whether the cyst was located predominately below the forniceal columns or was superiorly recessed (forniceal column separation with variable intraseptal extension). This comparative cohort study focused on clinical presentation, imaging features, operative technique, and patient outcome. RESULTS In total, 182 patients were identified. Seventeen patients had colloid cysts that were defined as superiorly recessed and underwent transseptal interforniceal removal, and 165 patients underwent a standard transforaminal approach. Patients had similar demographic characteristics. However, transseptal cysts were on average larger (17.8 mm vs 11.4 mm, p < 0.0001), and these patients had a greater frontal-occipital horn ratio (0.45 vs 0.41, p = 0.012). They were also more likely to have undergone a previous resection (p = 0.02). The two cohorts had similar surgical outcomes, with no differences in extent of resection, recurrence, or complications. CONCLUSIONS Superiorly recessed intraseptal colloid cysts are larger and tend to splay the bodies of the fornix, thus requiring a parasagittal transseptal interforniceal endoscopic approach. This achieves complete removal with comparatively negligible morbidity or rare recurrence (5.9%).
Collapse
Affiliation(s)
- Umberto Tosi
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Rafael Uribe-Cardenas
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Jacques Lara-Reyna
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Francis N Villamater
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Imali Perera
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Philip E Stieg
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Apostolos John Tsiouris
- 3Department of Radiology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Mark M Souweidane
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
| |
Collapse
|
5
|
Mirone G, Vitulli F, Nastro A, Bernardo P, Ruggiero A, Spennato P, Cinalli G. Neuroendoscopic treatment of symptomatic cyst of the septum pellucidum in children: A case series. Clin Neurol Neurosurg 2021; 207:106671. [PMID: 34098238 DOI: 10.1016/j.clineuro.2021.106671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptomatic cysts of the septum pellucidum (CSP) are extremely rare in children and surgical indications are not well defined. A very careful clinical and neuroradiologic evaluation is necessary to consider a patient for surgical indication. METHODS We present a surgical series of 7 pediatric patients. Clinical and radiological features of the patients, including clinical presentation, previous treatment, pre, and post-operative MRI, immediate postoperative, neuropsychiatric assessment, and outcomes were reviewed. RESULTS There were 5 males and 2 females (mean age 8 yrs). Five patients presented a history of severe intermittent headaches, two of them were admitted with acute symptoms of raised intracranial pressure. One patient presented Epilepsy and ADHD and one patient had severe psychosis. Overall, psychiatric disorders were diagnosed in six patients, three patients had Intellectual Disability (ID). In all cases, the cyst presented a ballooning feature, with a mean volume of 18,36 cm3 (range 10,62-28,5) and significant lateral bulging of both layers. All were operated on endoscopically without complications. After surgery, a very significant decrease in cyst volume was observed (mean volume 5,68 cm3; range 3,18-10,1) with complete disappearance of the ballooning aspect. Headaches resolved in all patients. In two patients operated in emergency papilloedema and vision improved in the first week after surgery. No recurrence of the cysts was noted during follow-up in all patients. CONCLUSIONS CSP may be associated with behavioral or psychiatric problems also in children. Neuroendoscopic surgery is a safe and effective therapeutic modality to treat CSP presenting with symptoms and signs of intracranial hypertension with good clinical results.
Collapse
Affiliation(s)
- Giuseppe Mirone
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Francesca Vitulli
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Anna Nastro
- Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pia Bernardo
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alessandra Ruggiero
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
| |
Collapse
|