Cystic dilation of the ventriculus terminalis

Clinical article

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Object

The ventriculus terminalis, an embryological remnant consisting of the ependymal-lined space of the conus medullaris, can occasionally become symptomatic after cystic dilation. In the existing literature, consisting of 32 cases, the preferred type of management (conservative vs surgical) is still debated. The object of this study was to report the surgical results in a consecutive series of 10 adult patients with cystic dilation of the ventriculus terminalis (CDVT), to match them with data retrieved from the relevant literature, and specifically to validate a new recent clinical classification.

Methods

The authors reported 13 new cases of CDVT treated in the Department of Neurosurgery at University Hospital in Verona, Italy. Treatment modalities and clinical and radiological outcomes, both early and at follow-up, were analyzed and compared with a preoperative classification of clinical presentation, as established by de Moura Batista and colleagues (2008).

Results

Surgical treatment seemed to guarantee the resolution of CDVT. Dorsolumbar laminotomy, myelotomy, and cystic drainage were performed in 10 patients. Patients with Type I symptoms (nonspecific complaints) often presented with comorbidities (herniated disc or facet hypertrophy) confusing their clinical status. The surgical treatment of patients with Type I symptoms promoted good results only if the diagnosis of CDVT was definitive and symptoms had rapidly evolved. In patients with Type II (focal neurological deficits) and III (sphincter disturbances) symptoms, surgical treatment sustained improvement even at the late follow-up.

Conclusions

While confirming the usefulness of de Moura Batista and colleagues' classification in its impact on prognosis, the authors propose a revision of the classification with subgroups Type Ia (nonspecific symptoms without clear relation to CDVT), which is best treated conservatively, and Type Ib (rapid onset and invalidating unspecific complaints without comorbidities), which may benefit from surgical evacuation.

Abbreviations used in this paper:CDVT = cystic dilation of the ventriculus terminalis; ODI = Oswestry Disability Index; VT = ventriculus terminalis.

Article Information

Address correspondence to: Mario Ganau, M.D., M.S.B.M., Department of Neuroscience, University of Verona, Piazzale Stefani 1, Verona, Italy. email: mario.ganau@phd.units.it.

Please include this information when citing this paper: published online May 4, 2012; DOI: 10.3171/2012.4.SPINE11504.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Sagittal (left and upper center), coronal (lower center), and axial (right) contrast-enhanced MR images showing a T11–12 CDVT. Preoperative (A) and 1-year postsurgery (B) images demonstrating a dramatic but incomplete reduction of the cyst.

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    Intraoperative photograph obtained during a midline myelotomy for fenestration of a CDVT, showing an ovoid, smooth-walled CDVT filled with water-clear fluid. Further laboratory analysis confirmed biochemical characteristics similar to normal CSF.

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    Photomicrographs of histological samples obtained from the wall of a CDVT, showing an ependyma-lined wall without any evidence of neoplastic proliferation. H & E staining, original magnification ×200 (upper) and ×400 (lower).

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    Bar graph showing results of an analysis of clinical data from our cohort on admission (black bar) and at discharge (gray bar) from the ward. Note the sudden improvement of sciatica and sensory disturbances after surgical evacuation; every other symptom significantly reduced except for hypotrophy and hypotonia. disturb = disturbance.

References

1

Agrillo UTirendi MNNardi PV: Symptomatic cystic dilatation of V ventricle: case report and review of the literature. Eur Spine J 6:2812831997

2

Borius PYCintas PLagarrigue J: [Ventriculus terminalis dilatation in adults: a case report and review of the literature.]. Neurochirurgie 56:3863902010. (Fr)

3

Brisman JLLi MHamilton DMayberg MRNewell DW: Cystic dilation of the conus ventriculus terminalis presenting as an acute cauda equina syndrome relieved by decompression and cyst drainage: case report. Neurosurgery 58:E5852006

4

Celli PD'Andrea GTrillò GRoperto RAcqui MFerrante L: Cyst of the medullary conus: malformative persistence of terminal ventricle or compressive dilatation?. Neurosurg Rev 25:1031062002

5

Choi BHKim RCSuzuki MChoe W: The ventriculus terminalis and filum terminale of the human spinal cord. Hum Pathol 23:9169201992

6

Ciappetta PD'urso PILuzzi SIngravallo GCimmino AResta L: Cystic dilation of the ventriculus terminalis in adults. Case report. J Neurosurg Spine 8:92992008

7

Coleman LTZimmerman RARorke LB: Ventriculus terminalis of the conus medullaris: MR findings in children. AJNR Am J Neuroradiol 16:142114261995

8

de Moura Batista LAcioly MACarvalho CHEbner FHTatagiba M: Cystic lesion of the ventriculus terminalis: proposal for a new clinical classification. J Neurosurg Spine 8:1631682008

9

Dhillon RSMcKelvie PAWang YYHan TMurphy M: Cystic lesion of the ventriculus terminalis in an adult. J Clin Neurosci 17:160116032010

10

Dullerud RServer ABerg-Johnsen J: MR imaging of ventriculus terminalis of the conus medullaris. A report of two operated patients and a review of the literature. Acta Radiol 44:4444462003

11

Kernohan JW: The ventriculus terminalis: its growth and development. J Comp Neurol 38:1071251924

12

Korosue KShibasaki HKuroiwa YMachi TSawada KKitamura K: Cyst of the conus medullaris manifesting amyotrophic lateral sclerosis syndrome. Folia Psychiatr Neurol Jpn 35:5075101981

13

Liccardo GRuggeri FDe Cerchio LFloris RLunardi P: Fifth ventricle: an unusual cystic lesion of the conus medullaris. Spinal Cord 43:3813842005

14

Matsubayashi RUchino AKato AKudo SSakai SMurata S: Cystic dilatation of ventriculus terminalis in adults: MRI. Neuroradiology 40:45471998

15

Nassar SICorrell JWHousepian EM: Intramedullary cystic lesions of the conus medullaris. J Neurol Neurosurg Psychiatry 31:1061091968

16

Sigal RDenys AHalimi PShapeero LDoyon DBoudghène F: Ventriculus terminalis of the conus medullaris: MR imaging in four patients with congenital dilatation. AJNR Am J Neuroradiol 12:7337371991

17

Stewart DH JrKing RBLourie H: Surgical drainage of cyst of the conus medullaris. Report of three cases. J Neurosurg 33:1061101970

18

Unsinn KMMader RGassner IKreczy AFreund MC: Sonography of the ventriculus terminalis in newborns. AJNR Am J Neuroradiol 17:100310041996

19

Wittenberg RHBötel UOppel U: Magnetic resonance imaging of intramedullary and intradural cyst causing acute paraplegia. Spine 16:2322351991

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