Cavum septi pellucidi cysts: a survey about clinical indications and surgical management strategies.
BACKGROUND
Cavum septi pellucidi (CSP) cysts have a very low incidence (0.04%). Symptomatic patients usually present aspecific symptoms. For this reason, the management of these patients is still debated.


METHODS
We selected the case of a ten year old patient, with a clinical history of frontal morning headaches and difficulty in concentration. Brain MRI documented a septum pellucidum cyst and a moderate biventricular dilation. We submitted the case, and a questionnaire concerning indications to surgery and management options to an international group of 54 pediatric neurosurgeons, analyzing the results and comparing them with the current literature.


RESULTS
The majority of the participants (50%) indicated as appropriate at the early stage only a clinical observation. In case of persistence of clinical symptoms, 58% opted for intracranial pressure (ICP) monitoring, which, if raised, was considered by 91% as an adequate indication to proceed with surgical treatment. A total of 98% of the participants indicated endoscopic fenestration of the cyst as the preferred surgical strategy.


CONCLUSIONS
The management of symptomatic patients with CSP cyst is controversial. Our results suggest that in most of the patients with aspecific symptoms, clinical observation and eventually ICP monitoring are adequate to identify patients for surgery.
a Department of Neurosurgery, Catholic University School of Medicine , Rome , Italy.
Gianpiero
G
Tamburrini
a Department of Neurosurgery, Catholic University School of Medicine , Rome , Italy.
Pier Paolo
PP
Mattogno
b Department of Neurosurgery, The Royal London Hospital , United Kingdom.
Ganaselingham
G
Narenthiran
a Department of Neurosurgery, Catholic University School of Medicine , Rome , Italy.
Massimo
M
Caldarelli
c Department of Pediatric Neurosurgery, INI International Neuroscience Institute-Hannover, Otto Von Guericke University , Magdeburg , Germany.
Concezio
C
Di Rocco
D001932:Brain Neoplasms / Q000601:surgery*; D020863:Central Nervous System Cysts / Q000601:surgery*; D002648:Child; D000072700:Conservative Treatment / Q000706:statistics & numerical data; D020773:Headache Disorders / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D044583:Neuroendoscopy / Q000706:statistics & numerical data; D059408:Pain Management; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012688:Septum Pellucidum / Q000601:surgery*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data
Cavum septum pellucidum cysts; cyst fenestation; symptomatic cysts