The Prevalence of Cavum Septum Pellucidum in Mental Disorders Revealed by MRI: A Meta-Analysis.

OBJECTIVE: The prevalence of cavum septum pellucidum (CSP) in mental disorders, particularly schizophrenia spectrum disorders and mood disorders, remains uncertain. The authors used a meta-analytical approach to determine the prevalence of CSP in mental disorders and to compare these with the prevalence of CSP in psychiatrically healthy comparison subjects. METHODS: PubMed and Embase were systematically searched for relevant articles published as of January 9, 2018. After a quality assessment of individual studies using the Newcastle-Ottawa Scale, a random-effects model within Stata statistical software was used to synthesize 25 eligible studies that included 2,392 patients with mental disorders and 1,445 psychiatrically healthy comparison subjects. RESULTS: The prevalence of CSP of any size and large CSP was found to be significantly higher in individuals with mental disorders compared with healthy comparison subjects, and the prevalence of CSP in schizophrenia spectrum and mood disorders did not differ between the groups. CONCLUSIONS: The meta-regression with predefined covariance indicated that imaging parameters were not associated with the heterogeneity among original studies; however, the mean age of enrolled subjects was identified as a possible source of heterogeneity. No publication bias was found.

Ultrasound Measurements of Frontal Horns and the Cavum Septi Pellucidi in Healthy Fetuses in the Second and Third Trimesters of Pregnancy.

OBJECTIVES: To assess the visualization rate and size of the frontal horns (FHs) and cavum septi pellucidi (CSP) in healthy fetuses throughout pregnancy. METHODS: After Institutional Review Board approval, 522 consecutive uncomplicated singleton pregnancies between 15 and 39 gestational weeks were enrolled in the study. Ultrasound measurements of the anterior horn width (AHW), center from the horn distance (CFHD), distance from the FHs to the CSP, and CSP width were retrospectively performed using axial transventricular or transcerebellar planes. Available maternal body mass indices were recorded. RESULTS: At least 1 FH was seen in 78% of the cases. The mean AHW decreased over the second trimester and plateaued in the third trimester. The CFHD plateaued in the second trimester and increased in the third trimester. Downside FHs were generally larger than upside FHs. More FHs were measured in transventricular (69%) than transcerebellar (31%) planes. Frontal horns were seen with high, low, and no confidence in 57%, 21%, and 22% of cases, respectively. No-confidence rates were 17% in the second trimester and 42% in the third trimester. The CSP was not visualized in 4% of cases; 15 of 19 cases of a nonvisualized CSP were scanned between 18 and 37 weeks. Mean body mass indices ± SDs were 27.6 ± 6.7 kg/m2 for the patients in cases of a visualized CSP and 32.4 ± 9.1 kg/m2 for the patients in cases of a nonvisualized CSP. CONCLUSIONS: Normative data for the fetal FH and CSP width were established. Frontal horns are more frequently seen on transventricular views and are difficult to confidently assess in the late third trimester. This study challenges previously reported data that the CSP is seen in 100% of cases from 18 to 37 weeks.

An investigation of the standardization of fetal cavum septi pellucidi measurements using three-dimensional volumes of the fetal head.

PURPOSE: The purpose of this study was to measure the maximal width, middle width, and length of the cavum septi pellucidi (CSP) in normal fetuses, and compare these measurements obtained in the transthalamic (TT) plane with those obtained in the transventricular (TV) plane. METHOD: A prospective study was conducted of normal singleton fetuses, ranging from 18 to 36 weeks in gestational age. In each case, a three-dimensional volume of the fetal head was obtained in the TT plane for further offline measurements, then the maximal width, middle width, and length of the CSP in both the TT and TV planes were measured. Intraobserver and interobserver reproducibility was assessed, and curve estimation was used to assess the possible relationship between these measurements of CSP and gestational age (GA). RESULTS: A total of 267 normal fetuses were studied. The CSP width and length in TT and TV planes as a function of GA were analyzed using a quadratic regression model. Intraobserver and interobserver agreement of the CSP measurements was excellent overall (ICCs >0.9), with intraobserver and interobserver differences of less than 4%. CONCLUSION: Measurements of CSP in the TT and TV planes are equally reproducible.

Visualization of the cavum septi pellucidi, cavum Vergae, and cavum veli interpositi using magnetic resonance imaging.

PURPOSE: The morphology of the cavum septi pellucidi (CSP), cavum Vergae (CV), and cavum veli interpositi (CVI) has been infrequently explored with neuroimaging. The aim of the present study was to delineate these cavities using magnetic resonance (MR) imaging. METHODS: A total of 71 patients were enrolled in the present study. Following initial examinations with conventional MR sequences, constructive interference in steady-state (CISS) sequence was performed in the coronal and sagittal sections for 60 and 11 patients, respectively. RESULTS: The coronal CISS images at the level of the aqueduct showed two distinct morphologies of the CV roof, one formed by the fornices with varying degrees of conjugation and the other formed by the corpus callosum with completely separated fornices. Appearance of the CSP was classified into four distinct types. Furthermore, the CVI presented two distinct appearances. CONCLUSIONS: Typically, the CSP, CV, and CVI present with asymptomatic conditions with morphological variabilities. Visualization of the CSP, CV, and CVI using the CISS sequences may be useful when managing lesions affecting these cavities.

[Septal Activation and Control of Limbic Structures].

Coherent activation of limbic system structures as the main function of theta-rhythm is widely discussed in the literature. However until now does not exist the common view on its generation in these brain structures. The model of septal theta-rhythmic activation and control of limbic structures is suggested basing on the literature and own experimental data.

Imaging of the septum pellucidum: normal, variants and pathology.

The septum pellucidum is a largely neglected anatomical midline structure during post-natal neuroimaging interpretation. Conversely, it is one of the anatomical landmarks used on pre-natal ultrasound to access normal midline formation. Because of its importance during the pre-natal period, the awareness of its primary malformative abnormalities is much higher than its disruptive acquired pathologies, often leading the misinterpretation. In this article, we will review the normal septum pellucidum formation, anatomy, and anatomical variants and will describe the imaging findings in primary malformative and secondary disruptive abnormalities affecting the septum pellucidum.

Technical considerations of endoscopic septostomy using a biportal approach in a case of hydrocephalus associated with tuberous sclerosis.

INTRODUCTION: We report herein the technical considerations for endoscopic septostomy in a case of hydrocephalus associated with tuberous sclerosis. CASE REPORT: A 17-year-old boy presented with visual and gait disturbances. Computed tomography revealed an intraventricular mass obstructing the foramen of Monro bilaterally and marked hydrocephalus. First, we planned a ventriculo-peritoneal shunt with endoscopic septostomy using a biportal approach to resolve the hydrocephalus. Guidance by a rigid endoscope inserted into the anterior horn of the left lateral ventricle allowed us to easily and safely perform septostomy using the fiberscope inserted into the anterior horn of the right lateral ventricle. CONCLUSION: A biportal approach such as the dual endoscopic technique is useful in the treatment of complicated intraventricular lesions with loss of midline structures.

Some observations on the septum pellucidum.

The thin, vertically placed partition consisting of two laminae separated by a narrow chink constitutes the cavity of the septum pellucidum, known from the time of Sylvius. Traumatic lesions in boxers, rare congenital expanding cysts causing hydrocephalus, and a number of septo-optic dysplasias give clinical significance to the septum and its related cavum.

Cavum septum pellucidum and first-episode psychosis: A meta-analysis.

OBJECTIVES: To investigate the prevalence and changes of cavum septum pellucidum (CSP) in first-episode psychosis (FEP) patients. METHODS: Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify eligible studies comparing FEP patients and healthy controls from inception to Feb 29, 2016. RESULTS: Ten cross-sectional studies and three longitudinal studies reported in ten articles met our criteria. Our meta-analysis found no significant differences in the prevalence of either "any CSP" (OR = 1.41; 95% CI 0.90-2.20; p = 0.13; I2 = 52.7%) or "large CSP" (OR = 1.10; 95% CI 0.77-1.58; p = 0.59; I2 = 24.1%) between FEP patients and healthy controls. However, the heterogeneity analysis of the prevalence of "any CSP" suggested bias in outcome reporting. CONCLUSIONS: The results based on current evidence suggest it is unclear whether "any CSP" is a risk factor for FEP due to the heterogeneity of the studies. There is insufficient evidence to support that "large CSP" is a possible risk factor for FEP.

Transcavum septum pellucidum interforniceal approach for the colloid cyst of the third ventricle Operative nuance.

BACKGROUND: Despite their unfavorable locations, lesions of the third ventricle can be successfully removed via an interhemispheric, transcallosal approach. In cases with normal ventricular anatomy, this approach requires unilateral or bilateral identification of the foramen of Monro. TECHNIQUE: However, in the presence of abnormal ventricular configuration such as cavum septum pellucidum (CSP), this basic knowledge needs to be modified. After routine callosotomy, there may be a confusion while entering the CSP due to the invisualization of ventricular landmarks such as the foramen of Monro, thalamostriate vein, and choroid plexus. The floor of the CSP is formed by the fornices, and a direct approach to the interforniceal area is easier via the CSP. But the interforniceal approach is not a routine way to reach the third ventricle, which has higher risks than other modalities. CONCLUSION: This approach should be planned and used in selected cases of the CSP. Opening of the walls of CSP is recommended both to expose both the foramen of Monro and to gain safe access to the third ventricle before manipulating the interforniceal area.

An anatomic review of thalamolimbic fiber tractography: ultra-high resolution direct visualization of thalamolimbic fibers anterior thalamic radiation, superolateral and inferomedial medial forebrain bundles, and newly identified septum pellucidum tract.

BACKGROUND: Images obtained through ultra-high-field 7.0-tesla magnetic resonance imaging with track-density imaging provide clear, high-resolution tractograms that have been hitherto unavailable, especially in deep brain areas such as the limbic and thalamic regions. This study is a largely pictorial description of the deep fiber tracts in the brain using track-density images obtained with 7.0-T diffusion-weighted imaging. METHODS: To identify the fiber tracts, we selected 3 sets of tractograms and performed interaxis correlation between them. These tractograms offered an opportunity to extract new information in areas that have previously been difficult to examine using either in vivo or in vitro human brain tractography. RESULTS: With this new technique, we identified 4 fiber tracts that have not previously been directly visualized in vivo: septum pellucidum tract, anterior thalamic radiation, superolateral medial forebrain bundle, and inferomedial forebrain bundle. CONCLUSIONS: We present the high-resolution images as a tool for researchers and clinicians working with neurodegenerative and psychiatric diseases, such as Parkinson disease, Alzheimer disease, and depression, in which the accurate positioning of deep brain stimulation is essential for precise targeting of nuclei and fiber tracts.

Cerebrospinal fluid reconstitution via a perfusion-based cadaveric model: feasibility study demonstrating surgical simulation of neuroendoscopic procedures.

Cadaveric surgical simulation carries the advantage of realistic anatomy and haptic feedback but has been historically difficult to model for intraventricular approaches given the need for active flow of CSF. This feasibility study was designed to simulate intraventricular neuroendoscopic approaches and techniques by reconstituting natural CSF flow in a cadaveric model. In 10 fresh human cadavers, a simple cervical laminectomy and dural opening were made, and a 12-gauge arterial catheter was introduced. Saline was continuously perfused at physiological CSF pressures to reconstitute the subarachnoid space and ventricles. A neuroendoscope was subsequently inserted via a standard right frontal bur hole. In 8 of the 10 cadavers, adequate reconstitution and endoscopic access of the lateral and third ventricles were achieved. In 2 cadavers, ventricular access was not feasible, perhaps because of a small ventricle size and/or deteriorated tissue quality. In all 8 cadavers with successful CSF flow reconstitution and endoscopic access, identifying the foramen of Monro was possible, as was performing septum pellucidotomy and endoscopic third ventriculostomy. Furthermore, navigation of the cerebral aqueduct, fourth ventricle, prepontine cistern, and suprasellar cistern via the lamina terminalis was possible, providing a complementary educational paradigm for resident education that cannot typically be performed in live surgery. Surgical simulation plays a critical and increasingly prominent role in surgical education, particularly for techniques with steep learning curves including intraventricular neuroendoscopic procedures. This novel model provides feasible and realistic surgical simulation of neuroendoscopic intraventricular procedures and approaches.

Evolutionary trends in limbic structures.

Structural differentiation and/or size of allocortical limbic structures (hippocampus, schizocortex, septum) are clearly more advanced in higher primates and man than in low (basal) Insectivora. In contrast, olfactory structures (olfactory bulb and olfactory cortices) are clearly smaller in higher Primates than in Insectivora. The opposite trends imply the existence of two functional systems in the allocortex (olfactory and limbic) being predominantly independent of one another. Within the hippocampus the greatest changes from Insectivora through Primates are found in area CA 1. The enlargement of CA 1 is clearly the highest within the hippocampus and its architectonic changes are striking. In the low Insectivora the CA 1 pyramidal layer is very dense and narrow. In Primates the pyramidal cells spread into the stratum oriens, and in man they are finally dispersed over the whole stratum and reach the alveus. In the schizocortex the enlargement of the entorhinal region is accompanied by structural differentiations which are reflected both in laminar and regional complexity.

Cavum septi pellucidi in normals and patients with schizophrenia as detected by magnetic resonance imaging.

Cavum septi pellucidi (CSP) is a cavity between the two leaflets of the septum pellucidum. CSP is a developmental anomaly, yet the pathologic implications, if any, of an abnormally large CSP remain unclear. The reported incidence of CSP among normal populations varies greatly from 0.15% to 85%. Several studies have suggested that there is a higher incidence of CSP in patients with schizophrenia. We conducted a thin-slice magnetic resonance imaging study to evaluate the prevalence of CSP in a sample of 75 controls and 55 patients. There was a high incidence of small CSP among both groups: 58.8% in the controls and 58.2% in the patients, suggesting that a small cavum could be considered a normal variant; however, the patient group had significantly higher incidence of large CSP (20.7%) compared to the normal group (3%). The patients with large CSP were all male.

Magnetic resonance imaging study of the cavum septi pellucidi in patients with schizophrenia.

OBJECTIVE: High-resolution magnetic resonance imaging was used to evaluate the prevalence of the cavum septi pellucidi (CSP) in 79 normal subjects and 86 patients with schizophrenia. METHOD: The CSP was assessed by counting the number of consecutive coronal 1-mm slices containing the CSP. A CSP equal to or greater than 6 mm in length was defined as large. RESULTS: The CSP was found in 74.4% of the patients and 74.7% of the normal subjects, a nonsignificant difference. No difference between groups was found in the prevalence of a large CSP. CONCLUSIONS: The findings support the idea that a small CSP is a normal anatomical variant. More cases of a large CSP are needed to elucidate the implications of this abnormality in schizophrenia.

Corticoseptal projections in the snakes Natrix sipedon and Thamnophis sirtalis.

The projections of the cerebral cortex upon the septum in water snakes (Natrix sipedon) and garter snakes. (Thamnophis sirtalis) were studied with the Fink-Heimer degeneration techniques. Two cortical areas send major projections to the septum. Medial cortex projects bilaterally to the dorsal portion of the precommissural septum along its full rostrocaudal extent. The ipsilateral projection is more massive than the contralateral one. Dorsal cortex projects ipsilaterally to a column within the septum which is present dorsally, caudal to the level of the anterior commissure, but shifts ventrally as the septum is followed rostrally. Lateral cortex may send a sparse projection to the ipsilateral ventral septum.

Connections of the parahippocampal cortex in the cat. IV. Subcortical efferents.

The present report deals with the projections from the entorhinal and perirhinal cortices to subcortical forebrain structures and the brainstem in the cat. By using anterograde and retrograde tracing techniques, it could be demonstrated that the entire mediolateral extent of the parahippocampal cortex issues prominent projections to the dorsal and ventral striatum, the amygdala, and the claustrum. In addition, the entorhinal cortex sends projections to the septum and the diagonal band of Broca. Only the perirhinal cortex gives rise to a weak projection to the dorsolateral periaquaductal gray and the ventral pontine region. The major proportion of the subcortical projections originates in the perirhinal cortex and the lateral entorhinal cortex, whereas the medial entorhinal cortex has a much sparser output and sends no fibers to the amygdala. The subcortical projections from both the entorhinal cortex and the perirhinal cortex arise mostly from their deep layers. It was further found that these projections are topographically organized along the mediolateral axis of the parahippocampal cortex. This mediolateral axis is related to a ventrolateral to dorsomedial axis in the septum, a mediolateral axis in the amygdala and the ventral striatum, and a ventrodorsal coordinate in the dorsal striatum and the claustrum. A further topography was observed in the projections from the perirhinal cortex to the lateral amygdaloid nucleus. A rostrocaudal axis in the perirhinal cortex corresponds to a mediolateral axis in the lateral amygdaloid nucleus. The present observations are compared with data concerning the connectivity of the parahippocampal cortex with the hippocampal formation and other cortical structures. It is suggested that the parahippocampal cortex in the cat may be conceptualized as an interface between the hippocampal formation and several subcortical structures in the realm of the limbic and motor systems.

Projections of the ventral subiculum to the amygdala, septum, and hypothalamus: a PHAL anterograde tract-tracing study in the rat.

The projections of the ventral subiculum are organized differentially along the dorsoventral (or septotemporal) axis of this cortical field, with more ventral regions playing a particularly important role in hippocampal communication with the amygdala, bed nuclei of the stria terminalis (BST), and rostral hypothalamus. In the present study we re-examined the projection of the ventral subiculum to these regions with the Phaseolus vulgaris leucoagglutinin (PHAL) method in the rat. The results confirm and extend earlier conclusions based primarily on the autoradiographic method. Projections from the ventral subiculum course either obliquely through the angular bundle to innervate the amygdala and adjacent parts of the temporal lobe, or follow the alveus and fimbria to the precommissural fornix and medial corticohypothalamic tract. The major amygdalar terminal field is centered in the posterior basomedial nucleus, while other structures that appear to be innervated include the piriformamygdaloid area, the posterior basolateral, posterior cortical, posterior, central, medial, and intercalated nuclei, and the nucleus of the lateral olfactory tract. Projections from the ventral subiculum reach the BST mainly by way of the precommissural fornix, and provide rather dense inputs to the anterodorsal area as well as the transverse and interfascicular nuclei. The medial corticohypothalamic tract is the main route taken by fibers from the ventral subiculum to the hypothalamus, where they innervate the medial preoptic area, "shell" of the ventromedial nucleus, dorsomedial nucleus, ventral premammillary nucleus, and cell-poor zone around the medial mammillary nucleus. We also observed a rather dense terminal field just dorsal to the suprachiasmatic nucleus that extends dorsally and caudally to fill the subparaventricular zone along the medial border of the anterior hypothalamic nucleus and ventrolateral border of the paraventricular nucleus. The general pattern of outputs to the hypothalamus and septum is strikingly similar for the ventral subiculum and suprachiasmatic nucleus, the endogenous circadian rhythm generator.

The islands of Calleja: organization and connections.

The islands of Calleja (IC) in the rate are composed of seven small groups of granule cells in the polymorph layer of the olfactory tubercle and one large group, the insula magna, which lies along the border between septum, nucleus accumbens and nucleus of the diagonal band. The cytoarchitecture and neuronal morphology of the IC and surrounding cells, studied using Nissl-stained and Golgi-Kopsch material, are described. In addition, the afferent and efferent connections of the IC were analyzed using fluorescence histochemistry, the autoradiographic tracing method, and the anterograde and retrograde horseradish peroxidase methods. Topographically organized projections to the IC from the dopamine-containing cells of the substantia nigra-ventral tegmental area are demonstrated by the glyoxylic acid fluorescence histochemical method and the autoradiographic tracing technique. Anterograde and retrograde horseradish peroxidase studies provide evidence for reciprocal, topographically organized interconnections between the IC and the septum, nucleus accumbens, amygdala and piriform cortex. These observations indicate that the IC constitute a unique population of granule cells, located in the olfactory tubercle, innervated by dopamine neurons of the mesencephalon and interconnected with olfactory and non-olfactory components of the basal forebrain.

An autoradiographic study of the commissural and ipsilateral hippocampo-dentate projections in the adult rat.

The distribution of the associational and commissural afferents to the inner one-fourth of the molecular layer of the dentate gyrus of the rat, has been studied autoradiographically following small injections of 3H-proline into the hilar region of the dentate (from which both groups of afferents arise). Different patterns of axonal labeling are observed after injections into the temporal (i.e., caudal), middle, or septal (rostral) thirds of the hippocampus. Thus after temporal injections labeled commissural and associational afferents are found only in the caudal third of the dentate gyrus, and the grain densities observed on the two sides are markedly asymmetrical around the short, or transverse, axis of the dentate. On the other hand, injections into the middle third of the hippocampus lead to extensive labeling of the commissural and associational afferents throughout the rostral two-thirds of the dentate gyrus, and their distribution, as judged by grain density estimates, is symmetrical on the two sides. Septal injections label fibers over the rostral half of the dentate, and again the labeling pattern on the two sides is asymmetrical (but in the reverse pattern from that seen after temporal injections). These distinctive patterns in the distribution of the two classes of afferents can generally be accounted for on the following assumptions: (1) the commissural and associational afferents share a common cytochemical specificity; (2) they compete with each other for the limited number of synaptic sites available upon the proximal portions of the granule cells: (3) the granule cells are generated along two distinct morphogenetic gradients:from the temporal to the septal pole of the dentate gyrus, and from the tip of its dorsal (or external) to the tip of its ventral (internal) blade; and (4) the first fibers to arrive monopolize the majority of the available synaptic sites, and those that reach their target field later, synapse predominantly upon the last-formed granule cell dendrites. To this extent our findings are consonant with the "temporal hypothesis" first formulated by Gottlieb and Cowan ('72). However, to account for the restricted distribution of afferents from the temporal part of the hippocampus, it is necessary to further postulate that there is some degree of topographic (or region-to-region) specificity in the ipsilateral and contralateral hippocampo-dentate projections.