Introduction: The septum pellucidum is a membrane that segments the anterior horns of the brain’s lateral ventricles. A vestigial structure, this partition extends from the corpus callosum’s anterior aspect to the body of the fornix, where the septal nuclei are housed. Between the septum’s leaves exists the cavum septum pellucidum (CSP). The cavum is present throughout gestational brain development and typically closes in early infancy. Rarely, the CSP persists and symptomatic cysts are discovered. Currently, no gold standard exists for the pediatric neurosurgical management of these cysts in the setting of modern imaging such as ultra-fast MRI and 3D/4D ultrasound.
Methods: Authors conducted a literature search between the years 2010 and 2022 directed at finding consistent management guidelines for CSP cysts. Terms utilized included: cavum, septum, pellucidum, cysts, pediatrics, neurosurgery, MRI and ultrasound. Approximately 40 articles were identified and included in this review.
Results: Despite numerous advancements in fetal and post-natal imaging, current literature lacks data that synthesizes pediatric neurosurgical management of CSP cysts with modern imaging techniques. Our search revealed that case reports dominate the landscape of CSP cyst literature and, while enlightening, lack salient guidelines and treatment recommendations. Additionally, CSP is often asymptomatic and persists into adulthood, and is not managed surgically. However, some cysts are symptomatic; additionally data were discovered that raise the possibility of CSP correlating with adult psychiatric disorders. Today’s pediatric neurosurgeon may not consider these anecdotal findings in the context of managing CSP cysts, leaving a blind spot.
Conclusion : There remains no definitive answer to the pediatric neurosurgeon’s approach to CSP cysts. Moreover, authors identified a dearth of guidelines and surgical techniques for this condition, including when utilizing modern imaging modalities. Until standards are established, it may be the pediatric neurosurgeon’s trial-and-error approach where advancement will be made in managing these rare but delicate patients.
