Simonin Alexandre, Bangash Omar, Chandran Arjun S, Uvelius Erik, Lind Christopher
Department of Neurosurgery, Sir Charles Gairdner Hospital (SCGH), Perth, Australia.
School of Medicine, University of Western Australia, Perth, Australia.
Oper Neurosurg (Hagerstown). 2020 Sep 15;19(4):E434-E439. doi: 10.1093/ons/opaa101.
Cavum septum pellucidum (CSP) and cavum vergae (CV) cysts are common incidental findings on imaging studies. However, they may rarely present with symptoms related to the obstruction of the foramen of Monro by the cyst leaflets. There is no consensus regarding the management of symptomatic CSP and CV cysts. We present an original transcavum interforniceal endoscopic fenestration technique. The step-by-step surgical procedure and two illustrative cases are presented.
A 31-yr-old male and a 24-yr-old woman presented with symptomatic CSP and CV cysts. For both patients, neuronavigation was used to plan the procedure. An endoscope was introduced into the cyst through a right frontal burr-hole. After an examination of the endoscopic anatomy, a communication between the cyst and the third ventricle was performed using an endoscopic forceps. In both cases, directly after the fenestration, cerebrospinal fluid (CSF) passed through the communication, and the collapse of the cyst was appreciated. Symptoms were relieved in both patients, and neuropsychological assessment improved. Postoperative imaging showed a reduction in the cyst bulge, and patent foramen of Monro.
Endoscopic fenestration of CSP and CV cysts to the third ventricle through an interforniceal navigated approach is a feasible and efficient surgical procedure. Theoretical advantages include a single tract through noneloquent brain, a perpendicular trajectory to the membrane for fenestration, and a large CSF space beyond the fenestration point.
透明隔腔（CSP）囊肿和穹窿腔（CV）囊肿是影像学检查中常见的偶然发现。然而，它们很少会出现因囊肿叶阻塞孟氏孔而导致的症状。对于有症状的CSP和CV囊肿的治疗，目前尚无共识。我们介绍一种原创的经腔间穹窿内镜开窗技术。文中展示了分步手术过程及两个病例说明。
一名31岁男性和一名24岁女性患有有症状的CSP和CV囊肿。对于这两名患者，均使用神经导航来规划手术。通过右侧额部钻孔将内镜引入囊肿。在内镜检查解剖结构后，使用内镜钳在囊肿与第三脑室之间建立连通。在这两个病例中，开窗后立即有脑脊液通过连通处，囊肿塌陷。两名患者的症状均得到缓解，神经心理学评估有所改善。术后影像学显示囊肿隆起减小，孟氏孔通畅。
通过间穹窿导航方法对CSP和CV囊肿进行内镜下向第三脑室开窗是一种可行且有效的手术方法。理论优势包括经非功能区脑的单一通道、开窗时与隔膜垂直的轨迹以及开窗点之外的大脑脊液空间。
