Cavum vergae cysts are rare lesions which are usually asymptomatic. It should not be confused with cavum septum pellucidum et vergae which is common. Although there is no actual pathological distinction between a run-of-the mill cavum vergae and a cavum vergae cyst, the later is sometimes used to denote a transverse diameter of more than 1cm 4 or when the outer margins are convex.
Cavum vergae cysts are rare congential lesions, gradually enlarging with time. As they are often asymptomatic the diagnosis may not be made until adulthood.
Usually asymptomatic. Occasionally the cyst is large enough to compress the midbrain tectum and aqueduct and result in obstructive hydrocephalus. Sometimes the cyst may be large enough to impair the normal drainage of the occipital and temporal horns of the lateral ventricles. In either case presentation is with signs and symptoms of raised intracranial pressure (morning headaches, worse on stooping etc..)
Ultrasound (in the neonatal or antenatal period), CT and MRI are all able to demonstrate cavum vergae cysts. Features consist of a cystic lesion located in the midline, which is located posterior to the foramen of Monro, below the posterior body and splenium of the corpus callosum and above the the fornices (which it often splays).
Treatment and prognosis
In most cases, patients are entirely asymptomatic and as such no treatment is required. If hydrocephalus is present then surgical options include:
- CSF shunting (leaving the cyst alone) e.g. VP or VA shunt
- open or endoscopic cysto-ventriculostomy
- stereotactically introduced catheter drainage of the cyst into the ventricles 1
- 1. Donauer E, Moringlane JR, Ostertag CB. Cavum vergae cyst as a cause of hydrocephalus, "almost forgotten"? Successful stereotactic treatment. Acta Neurochir (Wien). 1986;83 (1-2): 12-9. - Pubmed citation
- 2. Tortori-Donati P, Rossi A, Biancheri R. Pediatric Neuroradiology: Head and neck, spine. Springer. (2005) ISBN:3540410775. Read it at Google Books - Find it at Amazon
- 3. Ketonen L, Hiwatashi A, Sidhu R. Pediatric brain and spine, an atlas of MRI and spectroscopy. Springer Verlag. (2005) ISBN:3540213406. Read it at Google Books - Find it at Amazon
- 4. Kaufman HH. Cerebrospinal Fluid Collections. Thieme/AANS. (1997) ISBN:1879284480. Read it at Google Books - Find it at Amazon