Third Ventricular Cerebrospinal Fluid Cysts of Thalamic Origin: Review of Embryological Origin, Presentation and Management Strategies with a Case Series

• Published in: World neurosurgery 2017
• Main Authors: Vasquez, Ciro A., MD, Casey, Michael, MD, Folzenlogen, Zach, MD, Ormond, D. Ryan, MD, Lillehei, Kevin, MD, Youssef, A. Samy, MD, PhD
• Format: Article
• Language: English
• Subjects: Neurosurgery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2017.03.138

Abstract Objective Third ventricular cerebrospinal fluid (CSF) cysts of thalamic origin are very rare. The objective of this study is to review their possible pathogenesis, clinical presentation and management strategies with a case series describing management via an endoscopic approach with fenestration using a single burr hole technique. Methods A systematic literature review of reported cases of thalamic cysts was conducted with further meta-analysis of CSF cysts that involve the third ventricle. The mode of presentation, pathological analysis, surgical management and outcomes were analyzed. Results Twenty-two studies published between 1990 and 2013, reported 42 cases of thalamic cyst. Of those, 13 cases were consistent with CSF cyst that originated in the thalamus and involved the third ventricle. Eight cases (61.5%) were treated via endoscopic fenestration, 2 cases (15.4%) were surgically drained, 2 cases (15.4%) were stereotactically aspirated and one case (7.69%) was observed. The most common presenting symptoms were gait disturbance (26.3%) and headaches (26.3%) followed by tremors (15.8%) and weakness (15.8%). In our series, single burr hole technique was a successful definitive treatment with an average period of 23 months. Conclusion Third ventricular CSF cysts of thalamic origin most commonly present with hydrocephalus. They can be safely definitively treated via endoscopic fenestration to the CSF circulation using a single burr hole technique. Long term follow-up shows lasting improvement in symptoms without re-accumulation of the cyst.