Endoscopic Treatment of Symptomatic Septum Pellucidum Cyst in an Adult Patient—Case Report and Technical Notes

Background: Midline cysts of the brain are comprised of the following entities, septum pellucidum cysts, cavum vergae cysts and velum interpositum cysts. These lesions are uncommon and often asymptomatic; nonetheless, certain clinical manifestations may be linked to midline cysts, including headaches, signs of elevated intracranial pressure, neurological deficits, or alterations in mental status. Controversy persists in the therapy of symptomatic cases, mostly due to the challenge of establishing a correlation between the symptomatology and the presence of the cyst. Case description: We present the case of a 64-year-old female known with type—1 neurofibromatosis that associated a midline cyst. The cyst was treated endoscopically, in the initial stage (single wall perforation) showed no clinical or imagistic improvement. The incriminated symptoms in these cases are caused not only by compression or obstruction of the CSF flow but also to a complex alteration of CSF dynamics, in this case the stoma was found permeable at the second surgery but there was no obvious communication on the preoperative evaluation by ventriculocisternostomy. A second surgery was performed, with bilateral perforation and subsequent improvement of symptomatology and decrease of cyst dimensions. A literature review is presented concerning clinical presentation, therapeutic options, and possible outcomes. Conclusions: Endoscopic fenestration is an efficacious method for treating midline cysts, with bilateral wall fenestration representing the standard practice. Understanding the anatomical and developmental specifics of the septal region, together with cerebrospinal fluid dynamics, is essential for effective treatment of this condition.