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cavum_septum_pellucidum

Cavum septum pellucidum

upload.wikimedia.org_wikipedia_commons_7_7d_cavumseptumpellucidumdiagram.jpg

The cavum septi pellucidi (CSP) and cavum Vergae (CV) are persistent, primitive, or acquired, midline structures, fluid-filled, generally communicating located between the third ventricle and corpus callosum.

It is sometimes called the fifth ventricle.

Nonneoplastic cysts of the septum pellucidum are of two general forms. The first, the asymptomatic cavum septum pellucidum, is not a malformation or a true cyst and has been recognized since the time of Sylvius 1) 2)

Embriologically the leaves of the septum pellucidum enclose a cavity, the cavum septum pellucidum. This space first appears during the 3rd month of intrauterine growth by secondary cleavage of the banks of fusion of the cerebral hemispheres 3).

Epidemiology

A CSP is present in the normal fetus, but over 85% of them fuse by 3-6 months of age meaning that a CSP persists in ~15% of the adult population.

Gross anatomy

The CSP commonly occurs, and is often confused with the cavum vergae, which is situated posterior to the anterior columns of the fornix. During development, these spaces obliterate postero-anteriorly - the cavum vergae followed by the cavum septum pellucidum - and it is not uncommon that both occur together.

Boundaries

anterior: genu of the corpus callosum

superior: body of the corpus callosum

posterior: anterior limb and pillars of the fornix

inferior: anterior commissure and the rostrum of the corpus callosum

lateral: leaflets of the septum pellucidum

There have been various reports of their association with many behavioral and psychiatric disorders. Infrequently, they have been associated with an obstructive hydrocephalus-like picture. Although the structure and management of CSP has long been known, it has been an enigma as far as functional significance and management indications are concerned.

An absent cavum septum pellucidum in antenatal imaging is a concerning feature and is associated with significant CNS anomalies.

It is frequent among athletes with a history of repeated traumatic brain injury (TBI), such as boxers. Few studies of CSP in athletes, however, have assessed detailed features of the septum pellucidum in a case-control fashion. This is important because prevalence of CSP in the general population varies widely (2% to 85%) between studies. Further, rates of CSP among American pro-football players have not been described previously.

A retrospective study assessed retired American pro-football players presenting with cognitive/behavioral symptoms in whom structural MRI was available with slice thickness ≤2 mm (n=17). Each player was matched to a memory clinic control patient with no history of TBI. Scans were interpreted by raters blinded to clinical information and TBI/football history, who measured CSP grade (0-absent, 1-equivocal, 2-mild, 3-moderate, 4-severe) and length according to a standard protocol. Sixteen of 17 (94%) players had a CSP graded ≥2 compared with 3 of 17 (18%) controls. CSP was significantly higher grade (p<0.001) and longer in players than controls (mean length±standard deviation: 10.6 mm±5.4 vs. 1.1 mm±1.3, p<0.001). Among patients presenting to a memory clinic, long high-grade CSP was more frequent in retired pro-football players compared with patients without a history of TBI 4).

Differential diagnosis

Treatment

Symptomatic patients usually present aspecific symptoms. For this reason, the management of these patients is still debated.

TCD in the absence of other objective confirmatory studies, can aid in the diagnosis and provide information about the success of fenestration of the cavum septum 5).

Results suggest that in most of the patients with aspecific symptoms, clinical observation and eventually ICP monitoring are adequate to identify patients for surgery 6).


(1) Endoscopic fenestration of symptomatic CSP cysts is a safe treatment option. (2) Neurocognitive assessment is essential in the evaluation and outcome assessment of CSP 7).

Case series

A retrospective analysis of 3 patients who underwent endoscopic fenestration for CSP with obstructive hydrocephalus between 2012 and 2014 was done in the Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.

Data were analyzed for symptomatic clinical improvement in particular behavior.

Pre- and postoperative brain MRI showed a significant decrease in the size of the cyst as well as the ventricles. There were no recurrences during follow-up. All of the patients improved.

(1) Endoscopic fenestration of symptomatic CSP cysts is a safe treatment option. (2) Neurocognitive assessment is essential in the evaluation and outcome assessment of CSP 8).

Case reports

1997

The authors describe the morphological, histological and histo-immunological characteristics of an additional case of septum pellucidum-cavum Vergae cyst in a forty-year-old man who died the day following a ventriculo-peritoneal shunt 9).

1996

A giant CSP and CV cyst in an 18-month-old boy, extending to the posterior cranial fossa and causing hydrocephalus. The literature is reviewed, and the MRI and CT findings of the case are reported 10).

1)
Dandy WE: Congenital cerebral cysts of the cavum septi pellucidi (fifth ventricle) and cavum vergae (sixth ventricle). Diagnosis and treatment. Arch Neurol Psychiatry 25: 44–66,1931
2)
Wilson CB, Howieson J: Cysts of the septum pellucidum. Review and report of one case. Neurochirurgia 13: 93–99, 1970
3)
Rakic P, Yakovlev PI. Development of the corpus callosum and cavum septi in man. J Comp Neurol. 1968 Jan;132(1):45-72. PubMed PMID: 5293999.
4)
Gardner RC, Hess CP, Brus-Ramer M, Possin KL, Cohn-Sheehy BI, Kramer JH, Berger MS, Yaffe K, Miller B, Rabinovici GD. Cavum Septum Pellucidum in Retired American Pro-Football Players. J Neurotrauma. 2016 Jan 1;33(1):157-61. doi: 10.1089/neu.2014.3805. Epub 2015 Jul 17. PubMed PMID: 25970145.
5)
Bell RS, Vo AH, Dirks MS, Mossop C, Gilhooly JE, Cooper PB, Razumovsky AY, Armonda RA. Transcranial Doppler ultrasonography identifies symptomatic cavum septum pellucidum cyst: case report. J Vasc Interv Neurol. 2010 Jan;3(1):13-6. PubMed PMID: 22518255; PubMed Central PMCID: PMC3317289.
6)
Tamburrini G, Mattogno PP, Narenthiran G, Caldarelli M, Di Rocco C. Cavum septi pellucidi cysts: a survey about clinical indications and surgical management strategies. Br J Neurosurg. 2016 Sep 13:1-4. [Epub ahead of print] PubMed PMID: 27619551.
7)
Udayakumaran S, Onyia CU, Cherkil S. An Analysis of Outcome of Endoscopic Fenestration of Cavum Septum Pellucidum Cyst - More Grey than Black and White? Pediatr Neurosurg. 2017 Jun 10. doi: 10.1159/000474943. [Epub ahead of print] PubMed PMID: 28618406.
8)
Udayakumaran S, Onyia CU, Cherkil S. An Analysis of Outcome of Endoscopic Fenestration of Cavum Septum Pellucidum Cyst - More Grey than Black and White? Pediatr Neurosurg. 2017 Jun 10. doi: 10.1159/000474943. [Epub ahead of print] PubMed PMID: 28618406.
9)
Ronsin E, Grosskopf D, Perre J. Morphology and immunohistochemistry of a symptomatic septum pellucidum cavum Vergae cyst in man. Acta Neurochir (Wien). 1997;139(4):366-71; discussion 372. PubMed PMID: 9202780.
10)
Bayar MA, Gökçek C, Gökçek A, Edebali N, Buharali Z. Giant cyst of the cavum septi pellucidi and cavum Vergae with posterior cranial fossa extension: case report. Neuroradiology. 1996 May;38 Suppl 1:S187-9. PubMed PMID: 8811712.
cavum_septum_pellucidum.txt · Last modified: 2017/06/16 13:27 by administrador