Giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi.

The authors report a case study of a giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi spreading to the posterior fossa, and initially treated elsewhere by ventriculoperitoneal shunt, with no resolution of the symptomatology. A few months later the patient was successfully treated by fenestration into the ventricular system through a neuroendoscopic technique, at the Pediatric Neurosurgical Center of the Meyer Children's Hospital in Florence. Symptomatic midline cysts are quite rare and different techniques have been proposed for their treatment, i. e., direct craniotomy, conventional shunting, stereotactic approaches as well as endoscopic fenestration. In such cases neuroendoscopy obtains a good symptom resolution level, avoiding at the same time the risks of damage to endoventricular structures and often eliminates the need for a definitive ventriculoperitoneal shunt. In the present research the authors analyze the anatomy of the midline cavities and the mechanism through which a cyst may become symptomatic. The surgical endoscopic technique and the clinical and radiological assessments which confirmed the patency of the fenestration are also discussed. The authors conclude that endoscopic ventricular fenestration may represent the treatment of choice for this pathology.