PMC3512334_01
T2-weighted axial magnetic resonance imaging before (a) and after (b) surgery
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F1
Memory Scale-Revised test revealed significant memory disturbance including severe impairment of recall (general memory index, 75; delayed recall index, <50). MRI on admission revealed a large cystic lesion between the third and lateral ventricles, inside of which had the intensity equal to that of the cerebrospinal fluid [Figure 1a]. MRI after surgery confirmed a significant decrease in the size of the cyst [Figure 1b].
T2-weighted sagittal magnetic resonance imaging before surgery. The internal cerebral veins are located at the inferior margin of the cyst (arrow), and the fornix is compressed superiorly by the cyst (arrowhead)
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F2
The cyst compressed the fornix superiorly and the bilateral thalami laterally, whereas it did not involve the quadrigeminal cistern and displaced the internal cerebral veins inferiorly [Figure 2].
(a) Fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) before surgery revealing reduction in glucose metabolism of the medial aspects of the cerebrum (arrows) and bilateral thalami (arrowheads). (b) FDG-PET after surgery demonstrating improvement in glucose metabolism at the regions indicated on the preoperative image
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F3
FDG-PET revealed decreases in glucose metabolism in the bilateral thalami and medial aspects of the frontal and parietal lobes corresponding to the bilateral cingulate gyri [Figure 3a]. FDG-PET performed 20 days after surgery revealed improvement in glucose metabolism in the cingulate gyri and thalami [Figure 3b].
Endoscopic views. (a) View from the frontal horn of the right lateral ventricle showing a round protuberance on the septum pellucidum. The foramen of Monro, anterior septal, and thalamostriate vein are intact. (b) Small fenestration on the protuberance. (c) Semi-transparent true cyst wall under a thin ependymal membrane; the true cyst wall is held up with microforceps. (d) View of the interior of the cyst. The internal cerebral veins inferior to the cyst are seen through the semi-transparent cyst wall (arrows). Ant., anterior; For., foramen; Sept., septal; Str., striate; V., vein
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F4
The patient underwent an endoscopic cystoventriculostomy via the lateral ventricle [Figure 4].