Unilateral endoscopic fenestration for symptomatic cavum septum pellucidum cysts without hydrocephalus: a pediatric case series and surgical considerations - 22/07/26

Doi : 10.1016/j.neuchi.2026.101855

Anthony Joud ^a, Fred Bteich ^a,⁎ , Irene Stella ^a, Olivier Klein ^a,^b

^a Pediatric Neurosurgery Department, CHRU de Brabois, Nancy, France

^b Faculty of Medicine, University of Lorraine, Nancy, France

^⁎ Corresponding author.

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Highlights

•	Symptomatic cavum septum pellucidum (CSP) cysts without hydrocephalus remain rare in children.
•	Surgical treatment using unilateral endoscopic fenestration is a well-described, effective and safe technique in this series of three cases, with sustained clinical and radiological outcomes at one year postoperatively.
•	Neuronavigation improved the precision and safety of the surgical approach.
•	Surgical treatment may be considered even in the absence of hydrocephalus, particularly when clinical and/or radiological symptoms progress.
•	However, given the limited sample size and the retrospective nature of this study, these findings should be interpreted with caution, and further studies are needed to better define surgical indications in this setting.

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Abstract

Background

Cavum septum pellucidum (CSP) cysts are uncommon and usually asymptomatic midline lesions. While surgical management is well established in the presence of hydrocephalus, the indication for treatment in patients with symptoms but without hydrocephalus remains controversial.

Methods

We retrospectively reviewed three pediatric patients with lasting clinical manifestations and CSP cysts without hydrocephalus. They underwent a neuronavigation-assisted unilateral endoscopic fenestration between 2017 and 2024. Clinical and radiological outcomes were assessed, including interwall distance measured on MRI scans.

Results

All patients presented with headaches, associated with neurobehavioral symptoms in two cases. Interwall distance decreased in all patients, with a sustained mean reduction of 69.1% one year after the surgery. Clinical symptoms improved in all cases, with complete resolution of headaches. Mean follow-up was 2.8 years, with no recurrence.

Conclusion

Unilateral neuronavigation-assisted endoscopic fenestration appears to be a safe and effective minimally invasive treatment option in selected pediatric patients with clinically manifest CSP cysts without hydrocephalus.

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Keywords : Cavum septum pellucidum, pediatric neurosurgery, endoscopic fenestration, cyst, neuronavigation