Bilinmeyen Anatomik Patoloji Terminal Ventrikül Tedavi Stratejileri: Tek Merkez Deneyimi

Öz

Terminal ventrikül, konus medullariste bulunan, ependimal hücrelerle sınırlanan, santral kanalla ilişkili bir boşluktur. Literatürde sınırlı sayıda cerrahi yapılan olgu bildirilen, erişkinlerde oldukça nadir görülen bir anatomik yapıdır. Çocuklarda, beş yaşından önce gerilediği bilinen normal bir konjenital varyasyon olarak kabul edilmektedir ve hem pediatrik hem de yetişkin popülasyonda çok az sayıda semptomatik vaka rapor edilmiştir. Yetişkinlerde sıklıkla asemptomatiktir ve tesadüfen tespit edilir. Semptomlar nonspesifik bel ağrısından sfinkter fonksiyon bozukluğuna ve fokal nörolojik defisitlere kadar değişebilir. Amacımız nadir görülen bu patolojideki yönetim stratejimizi mevcut literatürle karşılaştırmalı olarak tartışmaktır. 2010-2020 yılları arasında hastaneye başvuran terminal ventrikül tanısı alan tüm erişkin hastalar (17 yaş ve üzeri) retrospektif olarak incelendi. Klinik sınıflandırma Batista'nın tanımladığı sınıflamaya göre yapıldı. Ayrıca Ganau'nun sınıflandırması da kullanıldı. Çalışmaya 5 hasta dahil edildi. Bu hastaların çoğunluğu (n=4, %80) tanı anında semptomatik olup, en sık görülen semptom nonspesifik sırt ağrısıydı (n=3, (%60). Hiçbir hastanın kliniğinde kötüleşme olmadı, takip süresi 21,6±8,9 aydı. Terminal ventrikül erişkinlerde de novo olarak gelişebilen, sıklıkla kist büyüyene kadar tanı konulamayan ve geniş bir semptom yelpazesiyle ortaya çıkabilen nadir bir patolojidir. Saptandığında, gerektiğinde cerrahiyi ve uygun olduğunda konservatif bir yaklaşımı içeren dikkatli bir tedavi gerektirir.

Anahtar Kelimeler

• Terminal ventrikül
• kauda equina
• beşinci ventrikül
• spinal kord

Treatment Strategies for Unknown Anatomic Pathology Ventriculus Terminalis Case Series: Single Center Experience

Öz

The ventriculus terminalis is a cavity in the conus medullaris, bounded by ependymal cells, associated with the central canal. It is an anatomical structure that is very rare in adults, with a limited number of surgical cases that have been reported in the literature. In children, it is regarded as a normal congenital variation, known to regress before five years of age, and very few symptomatic cases have been reported in both pediatric and adult populations. It is often asymptomatic in adults and is detected incidentally. Although potentially nonsignificant individually, symptoms can range from nonspecific low back pain to sphincter dysfunction and focal neurologic deficits. Our purpose is to discuss our management strategy in comparison to the existing literature. A retrospective review was conducted of all adult patients (aged 17 years and older) diagnosed with ventriculus terminalis who were referred to the hospital between 2010 and 2020. Clinical classification was made according to the classification defined by Batista. In addition, Ganau's classification was also used. Five patients were included in the study. The majority of these patients (n=4, 80%) were symptomatic at the time of diagnosis, with nonspecific back pain being the most common symptom (n=3, (60%). None of the patients required neurosurgical intervention during the follow-up period of 21.6±8.9 months, as there was no clinical deterioration observed. Ventriculus terminalis is a rare pathology that may develop de novo in adults, often remaining undiagnosed until the cyst enlarges, and can manifest with a wide spectrum of symptoms. When identified, it requires careful management, involving surgery when necessary and a conservative approach when appropriate.

Anahtar Kelimeler

• Ventriculus terminalis
• cauda equina
• fifth ventricle
• spinal cord

Kaynakça

1. 1.Milhorat TH, Bolognese PA, Black KS, Woldenberg RF. Acute syringomyelia: case report. Neurosurgery 2003;53(5):1220-1.
2. 2.Milhorat TH, Capocelli AL Jr, Anzil AP, Kotzen RM, Milhorat RH. Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg 1995;82(5):802-812.
3. 3.Zeinali M, Safari H, Rasras S, et al. Cystic dilation of aventriculus terminalis. Case report and review of the literature.Brit J Neurosurg 2019;33(3):294-298.
4. 4.Kernohan JW. The ventriculus terminalis: Its growth and development. J Comp Neurol 1924;38:107-125.
5. 5.Woodley-Cook J, Konieczny M, Spears J. The Slowly Enlarging Ventriculus Terminalis. Pol J Radiol 2016;7;81:529-531.
6. 6.Zhang L, Zhang Z, Yang W, et al. Cystic Dilation of the Ventriculus Terminalis: Report of 6 Surgical Cases Treated with Cyst-Subarachnoid Shunting Using a T-Catheter. World Neurosurg 2017;104:522-527.
7. 7.Suh SH, Chung TS, Lee SK, Cho YE, Kim KS. Ventriculus terminalis in adults: unusual magnetic resonance imaging features and review of the literature. Korean J Radiol 2012;13(5):557-563.
8. 8.Ganau M, Talacchi A, Cecchi PC, et al. Cystic dilation of the ventriculus terminalis. J Neurosurg-Spine 2012;17(1):86-92.

9. 9.Tancioni F, Di Ieva A, Gaetani P, et al. De novo Formation of the Ventriculus Terminalis? A Brief Report of a Special Case. Neuroradiol J 2007;28;20(1):71-74.
10. 10.Weisbrod LJ, Liu C, Surdell D. Enlarging Ventriculus Terminalis in a Patient With Polyarteritis Nodosa. Cureus 2021;13(4):e14460.
11. 11.Şimşek H, Zorlu E. Cystic lesion of the ventriculus terminalis accompanied by split cord malformation. Spine J 2016;16(11):e739.
12. 12.Pencovich N, Ben-Sira L, Constantini S. Massive cysticdilatation within a tethered filum terminale causing cauda equina compression and mimicking syringomyelia in a youngadult patient. Childs Nerv Sys 2013;29(1):141-144.
13. 13.Coleman LT, Zimmerman RA, Rorke LB. Ventriculus terminalis of the conus medullaris: MR findings in children. Am J Neuroradiol 1995;16(7):1421-1426.
14. 14.Severino R, Severino P. Surgery or not? A case of ventriculus terminalis in an adult patient. J Spine Surg 2017;3(3):475-480.
15. 15.Tuleasca C, Ducos Y, Knafo S, et al. Surgery for cyst dilatation of a ventriculus terminalis in adults: Keep it simple! Neurochirurgie 2021;67(2):211-213.
16. 16.Fletcher-Sandersjöö A, Edström E, Bartek J Jr, Elmi-Terander A.Surgical treatment for symptomatic ventriculus terminalis: case series and a literature review. Acta Neurochir (Wien)2019;161(9):1901-1908.
17. 17.Kawanishi M, Tanaka H, Yokoyama K, Yamada M. Cystic dilation of the ventriculus terminalis. J Neurosci Rural Pract 2016;7(4):581-583.
18. 18.de Moura Batista L, Acioly MA, Carvalho CH, Ebner FH,Tatagiba M. Cystic lesion of the ventriculus terminalis: proposal for a new clinical classification. J Neurosurg Spine 2008;8(2):163-168.
19. 19.Dhillon RS, McKelvie PA, Wang YY, Han T, Murphy M.Cystic lesion of the ventriculus terminalis in an adult. J Clin Neurosci 2010;17(12):1601-1603.
20. 20.Sansur CA, Sheehan JP, Sherman JH, Jane JA. Ventriculus terminalis causing back pain and urinary retention. Acta Neurochir (Wien) 2006;148(8):919-920.
21. 21.Helal A, Pirina A, Sorenson TJ, Palandri G. Fenestration ofSymptomatic Ventriculus Terminalis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021;15;20(4):E293.
22. 22.Domingo RA, Bohnen AM, Middlebrooks EH, Quinones-Hinojosa A, Abode-Iyamah K. T10-L3 Cystic Lesion of theVentriculus Terminalis Presenting as Conus Medullaris Syndrome. World Neurosurg 2020;136:146-149.
23. 23.Lotfinia I, Mahdkhah A. The cystic dilation of ventriculus terminalis with neurological symptoms: Three case reports anda literature review. J Spinal Cord Med 2018;41(6):741-747.
24. 24.Atallah O, Badary A, El-Ghandour NMF, et al. Cystic dilatation of the ventriculus terminalis: A narrative review. JCraniovertebr Junction Spine 2023;14(4):319-329.