Endoscopic Fenestration of A Symptomatic Cavum Septum Pellucidum:Technical Case Report

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-E491-ONS-E491 ◽  
Author(s):  
Astrid Weyerbrock ◽  
Todd Mainprize ◽  
James T. Rutka
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Pathological Condition ◽  
Obstructive Hydrocephalus ◽  
Invasive Technique ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Flow ◽  
Endoscopic Fenestration

Abstract OBJECTIVE: Cysts of the septum pellucidum (CSPs) may become symptomatic because of obstruction of cerebrospinal fluid flow, resulting in increased intracranial pressure and hydrocephalus requiring surgical intervention. Endoscopic fenestration may be the most effective and least invasive technique to treat this pathological condition. CLINICAL PRESENTATION: An 11-year-old boy sought treatment for frequent episodes of severe headache. On examination, he had papilledema. There was evidence on magnetic resonance imaging scans of a space-occupying CSP with obstructive hydrocephalus. INTERVENTION: The endoscopic technique of fenestration of both lateral walls of an enlarged CSP via a left frontal approach under ultrasound guidance using a rigid endoscope was successful. After surgery, the patient became asymptomatic, his papilledema resolved, and magnetic resonance imaging scans demonstrated collapse of the walls of the CSP toward the midline. CONCLUSION: Neuroendoscopic fenestration should be strongly considered as the treatment of choice for symptomatic CSPs. This procedure alone can lead to complete resolution of clinical symptoms and hydrocephalus, can reduce the size of the CSP, and can obviate the need for an implantable cerebrospinal fluid shunt.

SYRINGOPLEURAL SHUNT AS A RESCUE PROCEDURE IN PATIENTS WITH SYRINGOMYELIA REFRACTORY TO RESTORATION OF CEREBROSPINAL FLUID FLOW

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 471-476 ◽  
Author(s):  
Francesco Cacciola ◽  
Matteo Capozza ◽  
Paolo Perrini ◽  
Nicola Benedetto ◽  
Nicola Di Lorenzo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Magnetic Resonance ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Flow ◽  
Rescue Procedure

Abstract OBJECTIVE Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of cerebrospinal fluid homeostasis. Direct intervention on the syrinx is a difficult choice and should be considered a rescue procedure. Data in the literature examining the various options are scanty, with generally unsatisfying results. We report our experience with shunting of the syrinx into the pleural space. METHODS Twenty patients with syringomyelia refractory to cerebrospinal fluid flow restoration underwent a procedure for placement of a syringopleural shunt between 1998 and 2008. Modified Japanese Orthopaedic Association Scale scores and magnetic resonance imaging were available for each patient preoperatively and at the latest follow-up evaluation. A 2-tailed Wilcoxon signed-rank test was used for statistical analysis. Complications related to the operative procedure and to hardware failure were noted. RESULTS Nineteen patients were available for follow-up with a mean duration of 37.5 (standard deviation, 31.1) months. The condition of 1 patient deteriorated, 2 remained stable, and the remainder improved. The overall mean improvement on the Modified Japanese Orthopaedic Association Scale was 19.5% (95% confidence interval, 8.5–30.5). The median improvement was 4 points on the 17-point scale. Results were statistically significant (P < 0.001). Follow-up magnetic resonance imaging showed syrinx collapse in 17 cases and marked shrinkage in 2 cases. Except for 1 case of meningitis followed by fatal pulmonary embolism, no significant complications were noted. CONCLUSION A syrinopleural shunt should, in our view, be the syrinx diversion procedure of choice. More series of institutional experiences with a homogeneous approach would be helpful to verify this recommendation.

scholarly journals Ventricular pseudodiverticula from intraparenchymal cerebrospinal fluid dissection secondary to high-grade obstructive hydrocephalus in children: magnetic resonance imaging findings

2017 ◽  
Vol 30 (5) ◽  
pp. 425-428 ◽  
Author(s):  
Sonia F Calloni ◽  
Bruno P Soares ◽  
Thierry AGM Huisman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
White Matter ◽  
Magnetic Resonance ◽  
Obstructive Hydrocephalus ◽  
Ependymal Cells ◽  
Periventricular White Matter ◽  
Ventricular Wall ◽  
High Grade ◽  
Resonance Imaging

We report on a series of three children who presented with a focal cerebrospinal fluid collection within the periventricular white matter of the temporal and occipital lobes in the setting of high-grade obstructive hydrocephalus. Magnetic resonance imaging showed a focal defect within the ventricular wall associated with leakage of cerebrospinal fluid into the adjacent white matter. The white matter tracts appeared primarily displaced. This entity should be referred to as ventricular pseudodiverticulum, not lined by ependymal cells, in contrast to a true ventricular diverticulum in which the cerebrospinal fluid is contained by a focal outpouching of the intact ventricular wall lined by a dilated and prolapsed layer of ependymal cells. Correct interpretation and classification of the findings may be helpful in predicting prognosis and outcome.

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