title: Third Ventricular Cerebrospinal Fluid Cysts of Thalamic Origin: Review of Embryologic Origin, Presentation, and Management Strategies with a Case Series.
abstract: OBJECTIVE
  Third ventricular cerebrospinal fluid (CSF) cysts of thalamic origin are rare. The objective of this study is to review their possible pathogenesis, clinical presentation, and management strategies with a case series describing management via an endoscopic approach with fenestration using a single burr-hole technique.
  
  
  METHODS
  A systematic literature review of reported cases of thalamic cysts was conducted with further meta-analysis of CSF cysts that involve the third ventricle. The mode of presentation, pathologic analysis, surgical management, and outcomes were analyzed.
  
  
  RESULTS
  Twenty-two studies reported between 1990 and 2013 described 42 cases of thalamic cyst. Of those cases, 13 were consistent with CSF cyst that originated in the thalamus and involved the third ventricle. Eight cases (61.5%) were treated via endoscopic fenestration, 2 cases (15.4%) were surgically drained, 2 cases (15.4%) were stereotactically aspirated, and 1 case (7.69%) was observed. The most common presenting symptoms were gait disturbance (26.3%) and headaches (26.3%) followed by tremors (15.8%) and weakness (15.8%). In our series, a single burr-hole technique was a successful definitive treatment, with an average period of 23 months.
  
  
  CONCLUSIONS
  Third ventricular CSF cysts of thalamic origin most commonly present with hydrocephalus. They can be safely definitively treated via endoscopic fenestration to the CSF circulation using a single burr-hole technique. Long-term follow-up shows lasting improvement in symptoms without reaccumulation of the cyst.
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
authors.forename: Ciro A
authors.initials: CA
authors.lastname: Vasquez
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Casey
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
authors.forename: Zach
authors.initials: Z
authors.lastname: Folzenlogen
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Ormond
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lillehei
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado, USA. Electronic address: samy.youssef@ucdenver.edu.
authors.forename: A Samy
authors.initials: AS
authors.lastname: Youssef
mesh_terms: D002555:Cerebrospinal Fluid; D003560:Cysts / Q000150:complications / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D044583:Neuroendoscopy / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D013786:Thalamic Diseases / Q000150:complications / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D020542:Third Ventricle / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods
keywords: CSF; Cyst; Endoscopic fenestration; Thalamus; Third ventricle