Endoscopic Fenestration of Symptomatic Septum Pellucidum Cysts: Three Case Reports with Discussion on the Approaches and Technique

Abstract

Endoscopic fenestration is the treatment of choice for septum pellucidum cysts, where it results in immediate relief of the mass effect of the cyst and in the remission of the associated symptoms. We suggest a posterior approach through a right occipital burr hole. It allows one to easily cannulate the occipital horn, which is usually larger than the frontal one, thus avoiding the risk of damaging the vascular and neural structures surrounding the foramen of Monro. Besides, the endoscopic trajectory is in our opinion more direct. The two-window technique, with fenestration of the cyst into both lateral ventricles, improves the chances of long-term patency.

Endoscopic options in children: experience with 134 procedures

“…These results support the well-known high success rate observed with endoscopic procedures in cysts. 7,9,12,14,19,20,[26][27][28]34,35,39,46,47,50 Although again no definite conclusions can be drawn, possible reasons for these good results may reside in the superior intraoperative view that allows a very good orientation, in the preformed space within the cystic enlargement to maneuver without risk, in the frequent application of neuronavigation to more complex cases, and in the underlying causes of cyst formation. Because a slit valve mechanism has been discussed as an underlying cause of arachnoid growth, 35,41 no progression is expected after the cyst is opened.…”

“…Many different neuroendoscopic indications have since been described, and reports on successful endoscopic treatments for various pathological entities such as obstructive hydrocephalus of any origin, 1,[4][5][6]8,10,13,17,[21][22][23]25,[29][30][31][32]38,40,42,48,51 arachnoid cysts, 2,7,9,12,20,24,26,28,35,39,46,47,50 septum pellucidum cysts, 14,19,34 and intra-and paraventricular tumors 16,33 have been frequent. Even in rare cystic lesions 18 or idiopathic normal pressure hydrocephalus, 18 successful CSF circulation restoration has been described with endoscopy.…”

Neuroendoscopic surgery for unilateral hydrocephalus due to inflammatory obstruction of the Monro foramen

“…Several different endoscopic approaches are amenable to treat UH 5,9,15,16 . The neuroendoscope can be introduced into the enlarged or even the contralateral normal ventricle.…”

Neuroendoscopic Management of Symptomatic Septum Pellucidum Cavum Vergae Cyst Using a High-Definition Flexible Endoscopic System -Case Report-

“…2,5,6,8,9,11,12,16) The rigid endoscope is considered to provide clearer vision compared to the flexible neuroendoscope, but has the limitation of the operation field obtained by the single trajectory. In our case, we employed a high-resolution flexible neuroendoscopic system with a small CCD camera mounted at the tip of the flexible endoscope, 4) which provided surgical vision as clear as that provided by the rigid endoscope.…”

“…9) Surgical treatments include open surgical procedures, ventriculoperitoneal shunting, stereotactic fenestration, and neuroendoscopic cysto-ventriculostomy. 1,2,6,9,16) Neuroendoscopic fenestration using a rigid endoscope is a relatively recent technique that offers several advantages, 5,8,11,12,21,22) whereas neuroendoscopic fenestration using a flexible endoscope is less established. 6,8) Here we report a case of symptomatic CSP that was successfully treated by endoscopic fenestration using a flexible neuroendoscope.…”