Symptomatic cystic dilatation of V ventricle: Case report and review of the literature

Abstract

We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.

Fifth ventricle: an unusual cystic lesion of the conus medullaris

“…Moreover, MRI makes it possible to identify the isolated forms of the fifth ventricle by ruling out any association with other malformative lesions. 1,5,6,9,10,13 An analysis of the data shows that cystic dilatation of the fifth ventricle has two possible types of clinical evolution: in the first, there is a mild clinical onset characterized by a few, nonspecific symptoms and longterm stability of both clinical and radiological parameters, as in our case; alternatively, there may be an evolution of symptoms presumably due to an increase in the size of the cystic lesion inside the conus medullaris. 2 Once a diagnosis of fifth ventricle has been made, two types of treatment are possible: surgical or conservative.…”

“…[1][2][3][4][5][6][7] The process of neurulation, which begins at 3 weeks of embryonic age, leads to the formation of the neural tube by a progressive fusion of the lateral edges of the neural plate starting from the level, of the third and fourth somite. From this level, the fusion process progresses at the same time cephalad and caudad.…”

“…8 Localization of a syringomyelic cavity at the conus medullaris is a rare event and is always associated to a cranial extension. 1 A severe dorsolumbar spinal cord injury could be the 'primum movens' in the development of a cystic cavity (post-traumatic syringomyelia); the following increase in size of the lesion would be caused by medullary hemorrhagic necrosis phenomena. Other factors contributing to the lesion's enlargement would be fibrotic and arachnoiditic processes, secondary to post-traumatic meningeal hemorrhages, and transcystic pressure gradient modifications caused by post-traumatic stenosis and deformities of the vertebral canal.…”

“…Currently, most of the authors [1][2][3][4][5][6][7] believe that isolated cystic dilatation of the fifth ventricle is due to the persistence of this lesion in adulthood and to the abnormal closure of the communication between the ventriculus terminalis and the central canal by ependyma (disembryogentic theory).…”

“…Of the 17 cases described in the literature, 13 presented ingravescent or, at least, invalidating symptoms, 1,[5][6][7][8][9][10][11][12] whereas in the other 4, clinical status remained stable at follow-up. 2,6,13 However, clinical symptoms were entirely nonspecific, even in the cases that evolved, ranging from just low back pain (as in our case) to deficits (lower limb paresis, sphincter dysfunction, etc.).…”