Krejčí Tomáš, Vacek Petr, Krejčí Ondřej, Chlachula Martin, Szathmaryová Silvia, Lipina Radim
Department of Neurosurgery, University Hospital Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Czech Republic.
Department of Neurosurgery, Charles University Hospital in Pilsen, Pilsen, Czech Republic.
Clin Neurol Neurosurg. 2019 Oct;185:105494. doi: 10.1016/j.clineuro.2019.105494. Epub 2019 Aug 19.
Cysts of the Cavum septi pellucidi (CSP), cavum vergae (CV) and cavum veli interpositi (CVI) are anterior midline intracranial findings which are typically incidental - only rarely do we encounter symptomatic cysts of this type. Only a quite small number of these cysts series have been published, controversies regarding optimal management still exist.
This is a retrospective study of 10 patients treated at 2 clinics between 2002-2018. 9 patients underwent surgery and 1 is under long-term monitoring. Apart from demographic data, the study analyzed symptoms, cyst size and progression over time, ventricle size, complications, and treatment modality.
CSP with CV was found in 8 cases with 1 case each of CSP and CVI. The study comprised 6 men and 4 women, including 4 children. The mean follow-up time was 43.4 months. The average cyst size was 20.4 mm in CSP and 19.8 mm in CV; the CVI was 33 mm. Headache was most commonly reported (70%) followed by behavioral disturbance (30%). Disturbance in memory, psychomotor development, school performance, visual acuity, and vomiting was variously noted in 20%. The prevailing symptom was headache in adults and behavioral and autonomic disturbance in children. Postoperatively, cysts had reduced by an average of 44.3% while the ventricles remained unchanged. Symptoms resolved in all cases with residual problems in patients presenting with memory loss. No complications were noted.
Endoscopic fenestration is the method of choice in the treatment of symptomatic midline cysts. We recommend that any further research focuses on precisely establishing their clinical presentation, particularly neuropsychological symptoms.
透明隔腔（CSP）、穹窿腔（CV）和中间帆腔（CVI）囊肿是颅内前中线部位的病变，通常为偶然发现，此类有症状的囊肿很少见。仅有相当少量的此类囊肿系列报道发表，关于最佳治疗方案仍存在争议。
这是一项对2002年至2018年间在两家诊所接受治疗的10例患者的回顾性研究。9例患者接受了手术，1例接受长期监测。除人口统计学数据外，该研究分析了症状、囊肿大小及随时间的变化、脑室大小、并发症和治疗方式。
8例发现CSP合并CV，CSP和CVI各1例。该研究包括6名男性和4名女性，其中4名儿童。平均随访时间为43.4个月。CSP囊肿平均大小为20.4 mm，CV为19.8 mm；CVI为33 mm。最常报告的症状是头痛（70%）,其次是行为障碍（30%）。20%的患者出现记忆力、精神运动发育、学业表现、视力和呕吐等方面的不同程度障碍。成人中主要症状为头痛，儿童中为行为和自主神经障碍。术后，囊肿平均缩小44.3%，而脑室大小未变。所有病例症状均缓解，记忆力减退患者有残留问题。未观察到并发症。
内镜开窗术是治疗有症状的中线囊肿的首选方法。我们建议任何进一步的研究都应专注于准确确定其临床表现，尤其是神经心理学症状。
