Surgery or not? a case of ventriculus terminalis in an adult patient
The ventriculus terminalis (VT) is an intramedullary cavity containing cerebrospinal fluid (CSF), usually located at the conus, and representing an unsuccessful regression of a normal embryological phase of the development of the neural tube. Symptoms are not univocal and may vary from aspecific signs to sphincter dysfunctions and focal neurological deficits. The correct management of this condition is still object of debate, due to its rarity and its unpredictable behaviour in adult patients. Nevertheless two different studies have proposed a distinction for patients with cystic dilatation of VT basing on their symptoms, suggesting that only those patients with neurological deficits clearly related to the terminal ventricle could benefit from surgery. We describe a case of an adult patient with a progressive dilatation of a diagnosed VT that we treated surgically. A management flow-chart for this condition is then proposed, on the basis of our experience and after a review of the literature.