SEPTUM PELLUCIDUM VE VARYASYONLARININ MANYETİK REZONANS GÖRÜNTÜLEME İLE İNCELENMESİ

Öz

Amaç: Septum pellucidum (SP), lateral ventrikülün medial duvarını meydana getiren iki laminanın oluşturduğu ince tabakadır. Laminalar birleşmediğinde cavum septum pellucidum (CSP) veya Cavum Vergae (CV) adı verilen bir kavite oluşur. CSP patolojik önemi tam olarak aydınlatılamamış, gelişimsel bir anomalidir. CSP nöropsikiyatrik hastalıklarla, özellikle şizofreni ile ayrıca post-travmatik stres bozukluğu, Tourette hastalığı ile tekrarlayan ve ciddi kafa travmasına maruz kalan kişilerde sık görülmektedir. Ancak literatürde CSP morfolojisini sağlıklı bireylerde inceleyen çalışma sayısı çok azdır. Bu nedenle çalışmamızda septum pellucidum morfolojisini ve varyasyonlarını değerlendirmeyi amaçladık. Yöntem: Sakarya Üniversitesi Tıp Fakültesi/Sakarya Eğitim Araştırma Hastanesine başvuran ve Magnetik Resonans Görüntüleme (MRG) ile beyin görüntülemesi gerçekleştirilen 509 hastada septum pellucidum morfolojik açıdan retrospektif olarak değerlendirilmiştir. Bulgular: Olguların %11,98’inde CSP, %1,38’inde CV saptanmıştır. CSP saptanan bireylerin %55,74’ü erkek iken %44,26’sı kadındı. Çalışmada CSP uzunluğu ortalama 7.71±2,95 mm iken yüksekliği 2.80±1,12 mm olarak ölçüldü. SP uzunluğu ise ortalama 30.98±7,36 iken yüksekliği 11.89±3,32 mm olarak ölçüldü. Sonuç: Septum pellucidum varyasyonlarından olan CSP varlığının bilinmesi orta hat yerleşimli kistik kitle lezyonlarının ayrıcı tanısında oldukça önemlidir. Hacimsel değişikliklerinin çocukluk ve erişkinlikte psikiyatrik bozuklukların gelişimi ile ilişkili olabileceği düşünülmektedir.

Anahtar Kelimeler

• Septum pellicidum
• cavum septum pellucudi
• cavum vergae
• manyetik resonans görüntüleme

Investigation of septum pellucidum and its variations with magnetic resonance imaging

Abstract

Background/Aim: The septum pellucidum (SP) is the thin layer formed by the two laminas that form the medial wall of the lateral ventricle. When the laminas do not fuse, a cavity called cavum septum pellucidum (CSP) or Cavum Vergae (CV) forms. CSP is a developmental anomaly with unclear pathological significance and is common in people with neuropsychiatric diseases, especially schizophrenia, as well as post-traumatic stress disorder, Tourette's disease, and patients who suffer from recurrent and severe head trauma. However, few studies in the literature examine the CSP morphology among healthy individuals. Therefore, we aimed to evaluate the morphology and variations of septum pellucidum in healthy individuals. Methods: In this retrospective cohort study, the septum pellucidum was morphologically evaluated in 509 patients who underwent brain Magnetic Resonance Imaging (MRI) at Sakarya University Faculty of Medicine, Sakarya Training and Research Hospital. We classified the anatomical variations of the septum pellucidum as CSP, CV, CVI and evaluated their dimensions. Results: CSP was detected in 11.98% of the cases, and CV, in 1.38%. While 55.74% of individuals with CSP were male, 44.26 % were female. The mean CSP length and height were 7.71 (2.95) mm (P=0.103), and 2.80 (1.12) mm (P=0.649), respectively, and the mean length and height of the SP were 30.98 (7.36) mm (P=0.001), and 11.89 (3.32) mm (P=0.042), respectively. Conclusion: Knowledge of CSP, one of the septum pellucidum variations, is of great importance in the differential diagnosis of midline cystic mass lesions. Its volumetric changes may be related to the development of psychiatric disorders in childhood and adulthood.

Keywords

• Septum pellucidum
• Cavum septum pellucidum
• Cavum vergae
• Magnetic resonance imaging

Kaynakça

1. 1. Standring S. Gray’s Anatomy: the anatomical basis of clinical practice: 40th Edition, Churchill Livingstone Elsevier 2008; pp.241-243.
2. 2. Arıncı K, Alaittin E. Anatomi. 5.Baskı. Cilt 2. 2014;314.
3. 3. Sarwar M. The septum pellucidum: normal and abnormal. American Journal of Neuroradiology. 1989;10.5:989-1005.
4. 4. Harding BN. Malformations of the nervous system. In:Hume Adams J, Duchen LW (eds) Greenfield’s neuropathology, 5th ed. Edward Arnold, London, 1992;521–638.
5. 5. Aldur MM, Berker M, Celik HM, Sargon MF, Ugur Y, Dagdeviren A. The ultrastructure and immunohistochemistry of the septum pellucidum in a case of thalamic low-grade astrocytoma with review of literature. Neuroanatomy. 2002;1:7–11.
6. 6. Malinger G, Lev D, Kidron D, Heredia F, Hershkovitz R, Lerman-Sagie T. Differential diagnosis in fetuses with absent septum pellucidum. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2005;25(1):42-9.
7. 7. Degreef G, Lantos G Bogerts B Ashtari M J Lieberman. Abnormalities of the septum pellucidum on MR scans in first-episode schizophrenic patients. American Journal of Neuroradiology. 1992;13(3):835-40.
8. 8. Oktem H, Dilli A, Kurkcuoğlu A, Pelin C. Prevalence of Septum Pellucidum Variations: A Retrospective Study. Open Access Library Journal. 2018;5(11):1. doi: 10.4236/oalib.1105017.

9. 9. Born CM, Meisenzahl EM, Frodl T, Pfluger T, Reiser M, Möller HJ, Leinsinger GL. The septum pellucidum and its variants. European Archives of Psychiatry and Clinical Neuroscience. 2004;254(5):295-302.
10. 10. Sarnat HB, Curatolo P. Malformations of the Nervous System. Amsterdam: Elsevier B.V. 2008;533-56.
11. 11. Onur E, Alkın T, Ada E. The Relationship of Cavum Septum Pellucidum with Obsessive Compulsive Disorder and Tourette Disorder: A Case Report. Klinik Psikiyatri Dergisi. 2007;10(1):53-7.
12. 12. Sagır B, Binbay T, Ceylan D, Yalın N, Özerdem A, Alptekin K. Cavum Vergae and Schizophrenia: Brain Imaging Findings and Treatment Outcome of a Case with 25 Years of Untreated Psychosis. Turk Psikiyatri Dergisi. 2015;26:295-8.
13. 13. Yıldırım YE, Sert E, Aydın PÇ, Berkol TD, Kunt S. Two Cases of Schızophrenıa; The Relatıonshıp Between Cavum Septum Pellucıdum And Clınıcal Course. The Journal of Neurobehavioral. 2019;6(1):131-3.
14. 14. Falco P, Gabrielli S, Visentin A, Perolo A, Pil G, Bovicelli,L. Transabdominal Sonography of the Cavum Septum Pellucidum in Normal Fetuses in the Second and Third Trimesters of Pregnancy. Ultrasound in Obstetrics & Gynecology. 2000;16:549-53. doi: 10.1046/j.1469-0705.2000.00244
15. 15. Sundarakumar DK, Farley SA, Smith CM, Maravilla KR, Dighe MK. Nixon JN. Absent Cavum Septum Pellucidum: A Review with Emphasis on Associated Commissural Abnormalities. Pediatric Radiology. 2015;45:950-64. doi: 10.1007/s00247-015-3318-8
16. 16. Supprian T, Sian J, Heils A, Hofmann E, Warmuth-Metz M, Solymosi L. Isolated Absence of the Septum Pellucidum. Neuroradiology. 1999;41:563-6. doi: 10.1007/s002340050805
17. 17. De leucıo A, Dossanı, RH. Cavum Veli Interposit. In: StatPearls [Internet]. StatPearls Publishing, 2020. https://www.ncbi.nlm.nih.gov/books/NBK559000/
18. 18. Tsutsumı S, Ishii H, Ono H, Yasumoto Y. Visualization of the cavum septi pellucidi, cavum Vergae, and cavum veli interpositi using magnetic resonance imaging. Surgical and Radiologic Anatomy. 2018;40(2):159-64. doi: 10.1007/s00276-017-1935-7
19. 19. Deborah J, Paul DG. Normal appearances and dimensions of the foetal cavum septi pellucidi and vergae on in utero MR imaging. Neuroradiology. 2020;62:617–27. doi: 10.1007/s00234-020-02364-5
20. 20. Addario V, Pinto V, Rossi AC, Pintucci A, Di Cagno L. Cavum veli interpositi cyst:prenatal diagnosis and postnatal outcome. Ultrasound Obstet Gynecol e Off J Int Soc Ultrasound Obstet Gynecol. 2009;34(1):52-4.
21. 21. Behnaz M, Maryam R, Kolsoom K, Mohammad AK, Ahmad-Reza T. Cavum velum interpositum cysts in normal and anomalous fetuses in second trimester of pregnancy: Comparison of its size and prevalence. Taiwanese Journal of Obstetrics & Gynecology. 2019;58:814-9. doi: 10.1016/j.tjog.2019.09.016 1028-4559
22. 22. Dremmen MHG, Bouhuis RH, Blanken LME, Muetzel RL, Vernooij MW, Marroun H.E, Jaddoe VWV and et al. Cavum Septum Pellucidum in the General Pediatric Population and Its Relation to Surrounding Brain Structure Volumes, Cognitive Function, and Emotional or Behavioral Problems. American Journal of Neuroradiology. 2019;40(2):340-6. doi: 10.3174/ajnr.A593
23. 23. Raine A, Lee L, Yang Y, Colletti P. Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy. Br J Psychiatry. 2010;197(3):186–92.
24. 24. Filipović B, Teofilovski-Parapid G. Linear Parameters of Normal and Abnormal Cava Septi Pellucidi: A Post-Mortem Study. Clinical Anatomy. 2004;17:626-30. doi: 10.1002/ca.20014
25. 25. Funaki T, Makino Y, Arakawa Y, Hojo M, Kunieda T, Takagi Y, Takahashi JC, Miyamoto S. Arachnoid Cyst of the Velum Interpositum Originating from Tela Choroidea. Surgical Neurology International. 2012;3:120. doi: 10.4103/2152-7806.102334
26. 26. Dandy WE. Congenital cerebral cysts of the cavum septi pellucidi (fifth ventricle) and cavum vergae (sixth ventricle). Diagnosis and treatment. Arch Neurol Psychiatry. 1931; 25(1):44–66.
27. 27. Inaji T, Akimoto H, Hashiomoto T, Yamanaka S, Wada J, Miki T, Ito H. Neuroendoscopic fenestration of expanding cavum septi pellucidum: a case report. Jpn J Neurosurg. 2002;11:283–8.
28. 28. Amin BH. Symptomatic cyst of the septum pellucidum. Childs Nerv Syst. 1986;2(6):320–2.
29. 29. Gangemi M, Donati P, Maiuri F, Sigona L. Cyst of the velum interpositum treated by endoscopic fenestration, Surg. Neurol. 1997;47:134–7.