Symptomatic Cavum Septum Pellucidum and Vergae Cyst: A Case Report

Abstract: Background and Clinical Significance: Cavum septum pellucidum (CSP) and
cavum vergae (CV) are anatomical variations that may persist into childhood, adolescence,
or adulthood. When these cavities become abnormally large, they are classified as cysts. The
mechanism leading to expansion is poorly understood. Although rare, symptomatic CSP
and CV cysts can present with a wide range of clinical manifestations. Case Presentation:
A 20-year-old Caucasian male presented with progressively worsening symptoms over
several months including persistent headaches and dizziness. Neurological evaluation
showed no abnormalities, with intact cranial nerve function, normal muscle strength, and
no signs of paresis. Imaging identified CSP and CV cysts causing obstructive hydrocephalus.
MRI findings confirmed progressive cyst enlargement and obstruction of intraventricular
foramen. The patient underwent neuroendoscopic fenestration of the cyst with resolution
of both hydrocephalus and the symptoms. A CT and MRI scan of the brain performed
12 years before revealed a developmental variant, showing no evidence of cyst formation or
ventricular enlargement and without hydrocephalus at that time. This case provides a rare
opportunity to observe cyst growth dynamics over time. Conclusions: This case presents
the importance of recognizing symptomatic CSP and CV cysts as rare but significant
causes of obstructive hydrocephalus. The progression from a developmental variant to
cyst formation over time illustrates the value of long-term imaging follow-up in such cases.
Neuroendoscopic fenestration provided complete resolution of symptoms, demonstrating
the effectiveness of surgical intervention in such cases.