Expanding cyst of the septum pellucidum

Abstract

Expanding cysts of the septum pellucidum, although rare, may be a cause of significant neurological dysfunction. Most become symptomatic as a result of obstruction of the interventricular foramina and produce headaches, papilledema, emesis, and loss of consciousness. Behavioral, autonomic, and sensorimotor symptoms occur when an expanding cyst impinges on the structures of the hypothalamoseptal triangle or impairs the deep cerebral venous drainage. Neuroophthalmological symptoms may develop as a consequence of hydrocephalus or direct compression of visual structures. The authors describe the case of a young boy with an expanding septum pellucidum cyst who presented with a sudden, severe headache and loss of consciousness. In addition, he had a history of hyperactivity and progressively declining school performance. All symptoms resolved following decompression of the cyst. Seventeen cases from the literature are reviewed. The pathophysiological mechanisms underlying the development of symptoms secondary to expanding septum pellucidum cysts are outlined, and the related clinical neuroanatomy is described. A model is proposed for the natural history of expanding septum pellucidum cysts that provides a rational basis for understanding their clinical behavior and response to intervention. In most cases, fenestration or shunting will relieve the obstructive hydrocephalus and mass effect caused by the cyst and will produce rapid symptomatic improvement.

Conservative treatment of cysts of the cavum septum pellucidum presenting in childhood: report of 3 cases

“…Some of these symptoms include emotional lability, bizarre behavior, change in mental status, decline in academic performance, sleep disturbance, enuresis, incontinence, anorexia, abnormal epigastric sensation, disturbance in sleep pattern, hypothermia, and weight loss. 7,15 3. Distortion of vascular structures with deep venous drainage impairment.…”

“…Dandy first described the distortion in vascular structures while Aoki noticed the chronic impairment in deep venous drainage. 5,9,15 4. Compression of visual structures.…”

“…The visual structures can be compressed either directly, by the cyst, or indirectly, as a result of hydrocephalus. 13,15 The patient can present with nystagmus, sixth cranial nerve palsy, impaired visual acuity, visual field defects, papilledema, optic pallor, and retinal hemorrhages. 15 The most common treatment indication, however, is headache-often with no associated significant hydrocephalus.…”

“…13,15 The patient can present with nystagmus, sixth cranial nerve palsy, impaired visual acuity, visual field defects, papilledema, optic pallor, and retinal hemorrhages. 15 The most common treatment indication, however, is headache-often with no associated significant hydrocephalus. 7 Headache is a very common phenomenon in the general population; about 50% of adults report suffering from headaches over the previous year.…”

“…18 The finding is sometimes associated with repetitive head injuries, such as in boxers, and CSP is found at a higher rate among schizophrenics. 15 CSP cysts are defined as a lateral bowing of the septum pellucidum with a width greater than 1 cm. 19 These cysts are relatively rare, with a prevalence among patients undergoing imaging studies of approximately 0.04%.…”