title: Endoscope-Assisted Microsurgical Removal of an Intraventricular Ependymal Cyst That Manifested with Tremor.
abstract: BACKGROUND
  Intraventricular ependymal cysts (ECs) are rare, histologically benign neuroepithelial cysts. Most of these cysts are clinically silent and discovered incidentally. Rarely, they become symptomatic, leading to obstruction of the cerebrospinal fluid circulation. ECs located inside the ventricles may manifest with signs of increased intracranial pressure.
  
  
  METHODS
  A 32-year-old woman presented with a 6-year history of tremor affecting her left hand. In the last month, she had been experiencing headache as well, and the tremor of the left hand was affecting her quality of life. The patient demonstrated a fine resting and intention tremor of the left hand and a voice tremor. Magnetic resonance imaging revealed a large cystic, nonenhancing lesion within the right lateral ventricle. The fluid within the cyst was isointense to cerebrospinal fluid on all sequences. Because of the rapid progression of her symptoms and no response to medication, surgical decompression of the cyst was considered. The cyst was removed by an endoscope-assisted microsurgical technique. Her postoperative course was uneventful. A marked reduction in her tremor was noted in the immediate postoperative period. Histopathologic diagnosis was of an EC. During the follow-up period, the patient's tremor, although still present, had improved dramatically. At 6 months postoperatively, she could hold a drinking glass without spilling.
  
  
  CONCLUSIONS
  This is a unique case of an intraventricular EC that manifested with tremor, which improved by endoscope-assisted microsurgical removal of the cyst. This case also supports the important role of endoscopic surgery in the treatment of intraventricular cystic lesions.
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Kutlay
authors.affiliation: Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yavan
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Cahit
authors.initials: C
authors.lastname: Kural
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Ozer
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Daneyemez
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey. Electronic address: yusufizci@yahoo.com.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Izci
mesh_terms: D000328:Adult; D020863:Central Nervous System Cysts / Q000150:complications / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery; D004805:Ependyma / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D016896:Treatment Outcome; D014202:Tremor / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
keywords: Endoscopic surgery; Ependymal cyst; Lateral ventricle; Tremor