Cystic dilation of the ventriculus terminalis

Clinical article

Mario GanauSection of Neurosurgery, Department of Neuroscience, University of Verona;

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 M.D., M.S.B.M.
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Andrea TalacchiSection of Neurosurgery, Department of Neuroscience, University of Verona;

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 M.D.
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Paolo C. CecchiSection of Neurosurgery, Ospedale di Bolzano, Italy

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 M.D.
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Claudio GhimentonSection of Pathology and

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Massimo GerosaSection of Neurosurgery, Department of Neuroscience, University of Verona;

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 M.D.
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Franco FaccioliDepartment of Neurosurgery, University Hospital, Verona; and

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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.
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  • 1

    Agrillo U, , Tirendi MN, & Nardi PV: Symptomatic cystic dilatation of V ventricle: case report and review of the literature. Eur Spine J 6:281283, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Borius PY, , Cintas P, & Lagarrigue J: [Ventriculus terminalis dilatation in adults: a case report and review of the literature.]. Neurochirurgie 56:386390, 2010. (Fr)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Brisman JL, , Li M, , Hamilton D, , Mayberg MR, & Newell 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:E585, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Celli P, , D'Andrea G, , Trillò G, , Roperto R, , Acqui M, & Ferrante L: Cyst of the medullary conus: malformative persistence of terminal ventricle or compressive dilatation?. Neurosurg Rev 25:103106, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Choi BH, , Kim RC, , Suzuki M, & Choe W: The ventriculus terminalis and filum terminale of the human spinal cord. Hum Pathol 23:916920, 1992

  • 6

    Ciappetta P, , D'urso PI, , Luzzi S, , Ingravallo G, , Cimmino A, & Resta L: Cystic dilation of the ventriculus terminalis in adults. Case report. J Neurosurg Spine 8:9299, 2008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Coleman LT, , Zimmerman RA, & Rorke LB: Ventriculus terminalis of the conus medullaris: MR findings in children. AJNR Am J Neuroradiol 16:14211426, 1995

    • Search Google Scholar
    • Export Citation
  • 8

    de Moura Batista L, , Acioly MA, , Carvalho CH, , Ebner FH, & Tatagiba M: Cystic lesion of the ventriculus terminalis: proposal for a new clinical classification. J Neurosurg Spine 8:163168, 2008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Dhillon RS, , McKelvie PA, , Wang YY, , Han T, & Murphy M: Cystic lesion of the ventriculus terminalis in an adult. J Clin Neurosci 17:16011603, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Dullerud R, , Server A, & Berg-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 44:444446, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Kernohan JW: The ventriculus terminalis: its growth and development. J Comp Neurol 38:107125, 1924

  • 12

    Korosue K, , Shibasaki H, , Kuroiwa Y, , Machi T, , Sawada K, & Kitamura K, et al.: Cyst of the conus medullaris manifesting amyotrophic lateral sclerosis syndrome. Folia Psychiatr Neurol Jpn 35:507510, 1981

    • Search Google Scholar
    • Export Citation
  • 13

    Liccardo G, , Ruggeri F, , De Cerchio L, , Floris R, & Lunardi P: Fifth ventricle: an unusual cystic lesion of the conus medullaris. Spinal Cord 43:381384, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Matsubayashi R, , Uchino A, , Kato A, , Kudo S, , Sakai S, & Murata S: Cystic dilatation of ventriculus terminalis in adults: MRI. Neuroradiology 40:4547, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Nassar SI, , Correll JW, & Housepian EM: Intramedullary cystic lesions of the conus medullaris. J Neurol Neurosurg Psychiatry 31:106109, 1968

  • 16

    Sigal R, , Denys A, , Halimi P, , Shapeero L, , Doyon D, & Boudghène F: Ventriculus terminalis of the conus medullaris: MR imaging in four patients with congenital dilatation. AJNR Am J Neuroradiol 12:733737, 1991

    • Search Google Scholar
    • Export Citation
  • 17

    Stewart DH Jr, , King RB, & Lourie H: Surgical drainage of cyst of the conus medullaris. Report of three cases. J Neurosurg 33:106110, 1970

  • 18

    Unsinn KM, , Mader R, , Gassner I, , Kreczy A, & Freund MC: Sonography of the ventriculus terminalis in newborns. AJNR Am J Neuroradiol 17:10031004, 1996

    • Search Google Scholar
    • Export Citation
  • 19

    Wittenberg RH, , Bötel U, & Oppel U: Magnetic resonance imaging of intramedullary and intradural cyst causing acute paraplegia. Spine 16:232235, 1991

    • Search Google Scholar
    • Export Citation

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