Endoscope-Assisted Microsurgical Removal of an Intraventricular Ependymal Cyst Presented with Tremor

Publication date: Available online 5 March 2016
Source:World Neurosurgery
Author(s): Murat Kutlay, Ibrahim Yavan, Cahit Kural, Ilker Ozer, Mehmet K. Daneyemez, Yusuf Izci
BackgroundIntraventricular ependymal cysts (ECs) are rare, histologically benign neuroepithelial cysts. The majority of these cysts are clinically silent and discovered incidentally. Rarely, they become symptomatic leading to obstruction of the cerebrospinal fluid (CSF) circulation. Therefore, ECs located inside the ventricles may present with signs of raised intracranial pressure.Case DescriptionThis 32- year-old woman presented with a 6-year history of tremor affecting her left hand. In the last month, she was suffering from headache, and tremor of the left hand affecting quality of life. There was a fine resting and intention tremor on the left hand as well as a tremor of voice. Magnetic resonance imaging revealed a large cystic, nonenhancing lesion within the right lateral ventricle. The fluid within the cyst was isointense to CSF on all sequences. Because of the rapid progression of her symptoms and no response to medication, surgical decompression of the cyst was considered. The cyst was removed by endoscope-assisted microsurgical technique. Her postoperative course was uneventful. A marked reduction in her tremor was noted in the immediate postoperative period. Histopathologic diagnosis was of an ependymal cyst. At follow up period, although still present, the patient's tremor had improved dramatically. Six months postoperatively, she could hold a drinking glass without spilling.ConclusionThis is a unique case of intraventricular ependymal cyst presented with tremor and improved by endoscope-assisted microsurgical removal of the cyst. This case also supports the important role of endoscopic surgery in the treatment of intraventricular cystic lesions.

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