From the Research
The cavum septum pellucidum is generally a benign anatomical variant, but in rare cases, it can cause obstructive hydrocephalus, which requires urgent attention, as seen in a case where a toddler presented with episodic headaches and vomiting due to a large cavum septum pellucidum with obstructive hydrocephalus, which was successfully treated with endoscopic fenestration 1. The septum pellucidum itself is a thin membrane that separates the lateral ventricles of the brain. When the cavum remains open, it's generally considered an incidental finding on brain imaging studies and doesn't require any treatment or intervention. However, an unusually large cavum septum pellucidum has been associated with certain neurodevelopmental disorders and psychiatric conditions in some research studies, though a causal relationship hasn't been firmly established. Some key points to consider include:
- The presence of this cavity is determined by developmental factors during brain formation, particularly the growth of the corpus callosum and fornix.
- If discovered on imaging, it typically requires no follow-up unless it's associated with other abnormal findings or specific symptoms that might suggest a related neurological condition.
- In cases where the cavum septum pellucidum is causing symptoms, such as obstructive hydrocephalus, treatment with endoscopic fenestration has been shown to be effective, with significant improvement in symptoms and reduction in cyst size 2.
- The significance of a persistent cavum and its involvement in varied presentations, ranging from an incidental imaging finding to acute hydrocephalus, is still not fully understood and requires further study. It's also worth noting that the size of the cavum septum pellucidum can be correlated with injury severity, and regions that correlate most significantly with CSP size were the right entorhinal cortex and bilateral hippocampus, as seen in a study of traumatic brain injury 3. Additionally, a cleft cavum septum pellucidum has been associated with severe diffuse axonal injury, particularly in victims of fatal road traffic accidents 4. In children, symptomatic CSP cysts can be successfully treated with neuronavigation-assisted neuroendoscopy with bilateral fenestration, and the treatment is considered whenever there is an association of a CSP cyst on imaging studies and symptoms attributable to the obstruction of the cerebrospinal fluid flow or direct compression of surrounding structures by the cyst 5.