Cavum septum pellucidum cyst presenting with exercise-induced headaches: A technical report

Cavum septum pellucidum (CSP) is a normal anatomical variant that is largely asymptomatic, though in rare cases can cause headache, developmental delay, and even acute hydrocephalus. There exist many surgical treatments in these symptomatic cases, though no one treatment has been deemed superior. In this report, we describe bilateral fenestration of the septum pellucidum with flexible endoscopy via a right frontal approach in a patient with exercise-induced headaches. The patient is a 17-year-old male who experienced headaches for six years that were progressively worsening with exercise and bearing down with associated emesis. Imaging evaluation demonstrated a CSP cyst. The decision was made to treat via bilateral septostomy with flexible endoscopy. He progressed appropriately and his headaches have now resolved. There is debate regarding if unilateral vs bilateral septostomy, placement of CSF diversion device, or performing endoscopic third ventriculostomy is superior. In this report, we present a case where bilateral septostomy in a patient with episodic headache yields complete resolution of symptoms.