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Intraventricular chemotherapy via Ommaya reservoir is an important part of the treatment in patients with malignant central nervous system tumors. In these patients, catheter placement can be challenging due to the normal-sized ventricles. Intraoperative ultrasound guidance was used for Ommaya reservoir placement in a 56-year-old patient with multiple intracranial and leptomeningeal metastases who had cavum septum pellucidum et vergae malformation. The catheter was successfully placed into the frontal horn of the lateral ventricle outside the cavum. Intraoperative ultrasound is a suitable image guidance system in patients with slit-like or normal-sized ventricles. It can also be used in patients with ventricular malformations.

A persistent cavum septum pellucidum (CSP) is present in approximately 0.73% of adults, although its incidence ranges from 0.14 to 18.9% depending on the detection method. Cystic CSP is even rarer. A cyst causing mass within the CSP can obstruct the intraventricular foramen, leading to blockage of CSF flow and possible hydrocephalus, often justifying surgical intervention. We describe spontaneous decompression of a cystic CSP in a 36-year-old man. Initial MRI showed a cystic CSP with lateral bowing of the septal walls to 1.9 cm. Follow-up MRI 15 months later demonstrated no lateral bowing, and the septal wall width was 1.0 cm. This spontaneous decompression was not explained by the one previously described case report of cystic CSP regression.

CT findings, angiography and clinical course were analyzed in a series of 31 patients with a recent subarachnoid haemorrhage (SAH) from an aneurysm of the anterior communicating artery (ACoAA). It is shown that 3 types of bleedings can be distinguished according to the CT findings. In the first group (52%), suffering a mild or moderate bleeding into the basal cisterns and/or the cisterna lamina terminalis, the aneurysm mostly points downwards and is orientated straight in the midline, the Hunt and Hess Grade at admission is I or II and the prognosis following early surgery is good. In the second group (29%), the aneurysm mostly is orientated towards one side, additional bleeding occurs into the gyrus rectus and the mediobasal frontal lobe, they are in HH Grade II and III and the prognosis following surgery also is relatively good. In group three (19%) however, the aneurysm points upwards, they present with severe bleeding into the cisterna lamina terminalis, the cavum septum pellucidum and rupture into the putamen, hypothalamus and the ventricle. In this group, the HH grade at admission is IV or V and the prognosis is extremely unfavourable. It is concluded, that this classification may be used for decision on early surgery.