Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Interhemispheric cysts, often associated with agenesis of corpus callosum, are rare lesions. The optimal treatment is still controversial. Placement of cystoperitoneal shunt and open microsurgery are traditional treatments. Neuroendoscopy in children is due to its minimal invasiveness a new emerging option. There have been a few published cases on neuroendoscopic treatment of interhemispheric cyst in children. The authors document the youngest reported child with multiloculated interhemispheric cyst that was treated with neuroendoscopy. The cyst was detected in a male fetus in 35th week of gestation and in utero magnetic resonance imaging was performed in 37th week of gestation. After delivery, progressive macrocrania with signs of raised intracranial pressure developed. Endoscopic cystoventriculocisternostomy was performed 28 days after the birth. There was a marked symptom relief. One month after the surgery, magnetic resonance showed shrinkage of the cyst and expansion of the brain parenchyma. After a 2-month follow up period, the child showed normal neurologic development and head circumference increased by only 0.5 cm. The created fenestrations enabled the brain to expand. Neuroendoscopic treatment of interhemispheric cysts should be considered the operative technique of choice in newborns. Although the intracranial pressure and the size of the cyst have decreased, long-term follow up is necessary and future studies on more cases are needed.Interhemisferične ciste, često s pridruženom agenezom korpusa kalozuma, rijetko se pojavljuju. Optimalno liječenje je
još uvijek sporno. Cistoperitonealna drenaža i otvoreni mikrokirurški zahvat su tradicionalne metode. Neuroendoskopija u djece je obećavajuća metoda zbog svoje minimalne invazivnosti. Dosad je objavljeno svega nekoliko slučajeva neuroendoskopskog liječenja interhemisferične ciste u djece. U ovom članku su autori opisali slučaj najmlađeg djeteta s multilokularnom interhemisferičnom cistom operiranog neuroendoskopskom tehnikom. Cista je bila otkrivena u muškog fetusa u 35. tjednu trudnoće, a u 37. tjednu je učinjena magnetska rezonancija unutar maternice. Nakon poroda se razvio ubrzan rast glave i znaci povišenog intrakranijskog tlaka. Učinjena je endoskopska cistoventrikulocisternostomija 28. dana nakon poroda i nastupilo je značajno poboljšanje. Mjesec dana nakon zahvata kontrolna magnetska rezonancija je pokazala smanjivanje ciste i širenje tkiva mozga. Nakon dvomjesečnog praćenja utvrđen je normalan neurološki razvoj djeteta, a opseg glave je porastao za samo 0,5 cm. Otvori u membrani ciste su omogućili širenje mozga. Neuroendoskopsko liječenje interhemisferične ciste bi trebalo smatrati metodom izbora u novorođenčadi. Međutim, iako su se intrakranijski tlak i volumen ciste smanjili, potrebna su daljnja istraživanja na većem broju bolesnika i uz dugoročno praćenje
