Abstract
Background:Giant cysts of the midline, not associated to a tumor, are exceptional finding in the brain of adults. Here we present two cases of symptomatic giant cerebral cysts of the midline occurred in an elderly and in a young adult patients both treated with mini-invasive unilateral neuroendoscopic procedure. In the recent literature (since 1999) similar cases have not been reported. Beside the clinical report, review of literature and major anatomical features of the region are described.Case Description:These two adults (82 and 41 years old respectively) had a slow progressive development of headache, gait disturbances, memory impairment and urinary incontinence. Magnetic resonance imaging showed giant cyst of the midline and hydrocephalus. Surgery with the endoscopic procedure, through a right frontal burr hole, was followed by clinical and radiological improvement.Conclusion:Giant cerebral cysts of the midline in adults can be successfully treated through a neuroendoscopic monolateral approach that comprehends multiple openings, diffuse coagulation of the capsule, and careful releasing of capsule-ependyma adherences. Knowledge of major anatomical and developmental details of the septal region is necessary to avoid complication in a mini-invasive surgical procedure.
Highlights
Giant cysts of the midline, not associated to a tumor, are exceptional finding in the brain of adults
Cavum septi pellucidi (CSP), cavum vergae (CV) as well as cavum veli interpositi (CVI) are midline cerebrospinal fluid (CSF) collections that do not communicate with ventricles or subarachnoidal spaces and usually do not necessitate of any treatment
Reported as incidental findings at autopsy and during neuro‐radiological exams, their incidence decreases from premature birth to adult age. When such CSF collections are larger than 1 cm, they are called “cysts” of CSP, CV, CVI
Summary
Giant cerebral cysts of the midline in adults can be successfully treated through a neuroendoscopic monolateral approach that comprehends multiple openings, diffuse coagulation of the capsule, and careful releasing of capsule‐ependyma adherences. Reported as incidental findings at autopsy and during neuro‐radiological exams, their incidence decreases from premature birth to adult age. When such CSF collections are larger than 1 cm, they are called “cysts” of CSP, CV, CVI. We report on two cases of giant, cerebral cysts of the midline, remarkable like dimensions and age of appearance, which were treated with the endoscopic procedure. To our knowledge, these are the only two cases reported in adults since 1999. Through a right precoronal burr hole, the frontal horn of the ventricle was entered with a Storz‐Decq rigid endoscope (30° angled): Fenestration of the cyst was made and the shrinkage was facilitated by monopolar coagulation of the capsule [Figure 3a and b]
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