Cystic Dilation of the Conus Ventriculus Terminalis Presenting as an Acute Cauda Equina Syndrome Relieved by Decompression and Cyst Drainage: Case Report

Neurosurgical Service, Seattle Neuroscience Institute at Swedish Providence Hospital, Seattle, Washington, USA.
Neurosurgery (Impact Factor: 3.62). 04/2006; 58(3):E585; discussion E585. DOI: 10.1227/01.neu.0000197486.65781.88
Source: PubMed


The ventriculus terminalis of the conus, or "fifth ventricle" refers to the ependymal-lined space in the middle of the conus that is present in childhood and whose persistence into adulthood is rare. A number of cases of cystic dilatation of the ventriculus terminalis have been described in adulthood. Patients tend to present with either pain alone or gradually progressive conus or cauda equina syndromes with varying degrees of recovery after cyst drainage. Presentation with an acute cauda equina syndrome and its successful surgical management has not been previously reported.
A 57-year-old woman experienced back pain and bilateral sciatica ascribed to diabetic neuropathy for 2 years. Over a 24-hour period she developed bilateral lower extremity weakness, saddle anesthesia, and bowel and bladder incontinence. Lumbosacral magnetic resonance imaging demonstrated a large cystic dilatation of the ventriculus terminalis.
She was taken for emergency surgical decompression and cyst drainage. Immediately after surgery, she experienced significant increase in lower extremity strength and has since regained continence.
Cystic dilation of the ventriculus terminalis should be part of the differential diagnosis for a cauda equina syndrome; surgical decompression with simple cyst drainage can result in excellent clinical results.

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    • "The management of t adult VT is controversial, as some prefer non-operative management with serial imaging, while others favor surgical maneuvers for relief of neurological symptoms (4, 21-23). In our report, surgical or endovascular procedures were performed in 4 patients with progressing neurological symptoms. "
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    ABSTRACT: The ventriculus terminalis (VT) in adults is a rare pathology. We report various MR imaging features of the adult VT. Ten patients were included in this retrospective review.. All patients had undergone magnetic resonance (MR imaging with a surface coil that used two different 1.5T MR systems. All patients had undergone initial and follow-up MR imaging with contrast enhancement using gadopentate dimeglumine. Three patients underwent additional MR imaging using the echocardiogram-gated spatial modulation of magnetization (SPAMM) technique. If a shift in tagging band during the systolic phase was less than half of the band space, it was defined as a "non-pulsatile fluid". Two neuroradiologists independently reviewed these images, while clinical symptoms and outcomes were statistically analyzed between the treated and non-treated group. All cases presented an intramedullary cystic lesion in the conus medullaris and showed the same signal intensity as CSF. Three VTs had intracystic septation and cord edema, which were pathologically confirmed after surgery; two of these were associated with kyphotic deformity and spinal arteriovenous malformation. SPAMM-MRI of 3 patients demonstrated non-pulsatile fluid motion within the VT. In the treated group, clinical symptoms improved better than the non-treated group. The adult VT shows some unusual imaging features, including septation, cord edema, and coexistence of a spinal AVM, as well as the typical findings. Surgical maneuvers may be considered as a treatment option in adult VT with progressive neurological symptoms.
    Full-text · Article · Sep 2012 · Korean journal of radiology: official journal of the Korean Radiological Society
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    Preview · Article · Aug 1970 · Journal of Neurosurgery
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    ABSTRACT: Simple cysts found within the filum terminale of infants on lumbar spine sonography are relatively common, but no study has established their clinical significance. To obtain information on the sonographic features of isolated filar cysts and determine their clinical significance in comparison with age- and sex-matched controls. We performed a retrospective review of 644 consecutive spine sonograms in patients younger than 8 months. Gestational age- and sex-matched controls with normal lumbar sonograms were taken from the same period. We obtained short-term clinical follow-up of motor milestones for each group. The incidence of filar cyst was 78 of the 644 (11.8%) and was inversely related to age. Developmental follow-up of the study patients compared with control population showed no statistically significant difference in the ages at which the infants were able to turn over, crawl and walk. Follow-up MR imaging of 13 study patients (19%) failed to demonstrate filar cysts previously identified on sonography. No significant difference was found in the short-term outcome of infants with isolated filar cysts on lumbar sonography compared with that of a control population. Filar cysts should be considered a normal variant when found in isolation on lumbar sonography.
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