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Imamura K, Hayashi T, Kawano O, Sakai H, Masuda M, Morishita Y, Maeda T. Surgical treatment for cystic dilation of the ventriculus terminalis: A report of two cases. J Orthop Sci 2024; 29:354-356. [PMID: 35063333 DOI: 10.1016/j.jos.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 12/28/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Kiyoshiro Imamura
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Tetsuo Hayashi
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan; Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan.
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
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Restelli F, Mazzapicchi E, Cazzato D, Bonomo G, Labiad I, Asteggiano F, Lanteri P, Costa F. Exoscopic Removal of a Symptomatic Vth Ventricle Cyst (Kraus Ventriculus Terminalis) Under Ultrasonography and Neurophysiological Assistance: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e292-e293. [PMID: 37578263 DOI: 10.1227/ons.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/01/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Daniele Cazzato
- Neurophysiopathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
- Department of Neurosurgery, "G.Rodolico" University Hospital, Catania, Italy
| | - Ikrame Labiad
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | | | - Paola Lanteri
- Neurophysiopathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Francesco Costa
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
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Atallah O, Badary A, El-Ghandour NMF, Almealawy YF, Wireko AA, Syrmos N, Umana GE, Al-Barbarawi M, Ergen A, Shrestha P, Chaurasia B. Cystic dilatation of the ventriculus terminalis: A narrative review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:319-329. [PMID: 38268679 PMCID: PMC10805159 DOI: 10.4103/jcvjs.jcvjs_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/01/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Department of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | | | - Yasser F. Almealawy
- Department of Neurosurgery, Faculty of Medicine, University of Kufa, Kufa, Iraq
| | - Andrew Awuah Wireko
- Department of Neurosurgery, Faculty of Medicine, Sumy State University, Sumy, Ukraine
| | - Nikolaos Syrmos
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Centre, Gamma Knief Centre, Cannizzaro Hospital, Catania, Italy
| | | | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Derince, Kocaeli, Turkey
| | - Prabin Shrestha
- Department of Neurosurgery, Kathmandu Neuro and General Hospital, Kathmandu, Nepal
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Dasic D, Signorelli F, Ligarotti GKI, D'Onofrio GF, Rapisarda A, Syrmos N, Chibbaro S, Visocchi M, Ganau M. Cystic Dilatation of the Ventriculus Terminalis: Examining the Relevance of the Revised Operative Classification Through a Systematic Review of the Literature, 2011-2021. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:399-404. [PMID: 38153500 DOI: 10.1007/978-3-031-36084-8_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The literature features limited evidence on the natural history of the cystic dilatation of the ventriculus terminalis (CDVT) and its response to treatment. The goal of this study is to ascertain which impact the revised operative classification of CDVT had on the management of patients diagnosed over the past 10 years.Ten new clinical articles presenting a total of 30 cases of CDVT were identified and included for qualitative analysis. Two take-home messages can be identified: (1) Adequate consideration should be given to designing national pathways for referral to tertiary centers with relevant expertise in the management of lesions of the conus medullaris, and (2) we suggest that type Ia should be, at least initially, treated conservatively, whereas we reckon that the signs and symptoms described in types Ib, II, and III seem to benefit, although in some patients only partially, from surgical decompression in the form of cystic fenestration, cyst-subarachnoid shunting, or both.While the level of evidence gathered in this systematic review remains low because the literature on CDVT consists only of retrospective studies based on single-center series (level of evidence 4 according to the Oxford Centre for Evidence-Based Medicine (OCEBM)), the strength of recommendation for adopting the revised operative classification of CDVT is moderate.
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Affiliation(s)
- Davor Dasic
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Ginevra Federica D'Onofrio
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Salvatore Chibbaro
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | | | - Mario Ganau
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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Núñez Báez SG, De Jesus O, Labat EJ, Feliciano CE. Ventriculus terminalis or conus medullaris arachnoid cyst: a diagnostic dilemma. BMJ Case Rep 2022; 15:e250812. [PMID: 35623655 PMCID: PMC9150153 DOI: 10.1136/bcr-2022-250812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sergio G Núñez Báez
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Eduardo J Labat
- Department of Radiological Sciences and Diagnostic Radiology, Neuroradiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Caleb E Feliciano
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Baig Mirza A, Visagan R, Boardman T, Murphy C, Al-Ali B, Kellett C, Grahovac G. Recurrent terminal ventricle cyst: a case report. J Surg Case Rep 2021; 2021:rjab498. [PMID: 34804483 PMCID: PMC8598984 DOI: 10.1093/jscr/rjab498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
The terminal ventricle (TV) of Krause is a rare cystic dilation of the conus' central canal. Due to limited understanding surrounding its pathophysiology, optimal management remains controversial. We report a 25-year-old female presenting with acute paraparesis. Magnetic resonance imaging spine revealed a cystic conus medullaris lesion in keeping with an incidental TV cyst. However, the patient experienced a rapid resolution of symptoms. We hypothesize that the TV cyst spontaneously ruptured and auto-decompressed. To our knowledge, this is the first reported case of an enlarging symptomatic TV cyst with spontaneous rupture and resolution of symptoms, highlighting the variable natural history of this condition.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ravindran Visagan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy Boardman
- GKT School of Medical Education, King's College London, London, UK
| | - Christopher Murphy
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Bilal Al-Ali
- GKT School of Medical Education, King's College London, London, UK
| | - Christopher Kellett
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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Rigsby RK, Tong KA. Spontaneous Resolution of Diffuse Idiopathic Slit-Like "Syrinx" in a Pediatric Patient. Cureus 2021; 13:e17808. [PMID: 34660018 PMCID: PMC8498009 DOI: 10.7759/cureus.17808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
It is important to recognize that a prominent central canal of the spinal cord can be a normal variant and can spontaneously regress. A five-year-old male presented for evaluation of abnormal gait. Prior brain magnetic resonance imaging showed no hindbrain malformation, and the patient had no history of trauma. Full spine magnetic resonance imaging showed a vertical slit-like linear cavity within the center of the spinal cord, from C6-7 to the conus medullaris with a diameter ranging from 0.5 to 2 mm. This was initially reported as a syrinx. The patient's symptoms remained stable. Three years later, follow-up magnetic resonance imaging showed spontaneous resolution of the slit-like cavity. This case likely represented a prominent central canal (a normal variant) that underwent normal closure.
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Affiliation(s)
- Ryan K Rigsby
- Radiology, Loma Linda University Medical Center, Loma Linda, USA
| | - Karen A Tong
- Radiology, Loma Linda University Medical Center, Loma Linda, USA
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Abstract
Ventriculus terminalis (VT) is a cystic embryological remnant within the conus medullaris that normally regresses after birth. In rare cases, it may persist into adulthood and give rise to neurologic symptoms. The pathogenesis remains unclear but is thought to be related to failed embryonic regression with other proposed possible etiologies including vascular disturbances. We present an intriguing case of a slow-growing VT in a woman with progressive neurologic symptoms who experiences symptomatic relief following thoracic laminectomy and fenestration. Our case is the first to present a unique association with polyarteritis nodosa and only the third to report a case of documented enlargement of the VT over time successfully treated with surgical fenestration.
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Affiliation(s)
- Luke J Weisbrod
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Collin Liu
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Daniel Surdell
- Neurological Surgery, University of Nebraska Medical Center, Omaha, USA.,Neurosurgery, University of Nebraska Medical Center, Omaha, USA
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T10-L3 Cystic Lesion of the Ventriculus Terminalis Presenting as Conus Medullaris Syndrome. World Neurosurg 2020; 136:146-149. [DOI: 10.1016/j.wneu.2020.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/17/2022]
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