Endoscopic Removal of Third Ventricular Colloid Cyst

Abstract

Background: Third ventricular colloid cysts are benign lesions originating in the roof of the anterior third ventricle. They constitute around 1% of all intracranial tumors. The optimal surgical management of colloid cysts continues to be a matter of debate.Objective: This study was perfomed to assess the efficacy and safety of the endoscopic technique in treatment of 90 patients with colloid cysts.Methods: During the period from June 2001 to October 2011, 90 patients with third ventricular colloid cyst were operated by the endoscopic single burr hole approach. The age ranged between 16 and 67 years (mean 40.3 years). Fifty-eight were females. The cyst size ranged between 8 and 35 mm. In computed tomography (CT) scan, the cyst was hyperdense in 74 cases and isodense in 16 cases. The standard Kocher burr hole was used in 63 and a more both anterior and lateral burr hole was used in 27 cases. Total cyst removal was achieved in 79 patients. Cyst content evacuation and capsule coagulation was done in 10 cases; whereas partial cyst excision was made in 1 case. All patients were followed by a CT scan at 1 and 6 months time from the surgery and then at 2-year interval. The follow-up period ranged from 6 to 120 months with a mean of 62 months.Results: The operative time ranged between 60 and 175 minutes with a mean of 84 minutes. Ventriculostomy tube and prophylactic antiepileptics were not used for any of the cases. One patient needed ventricular shunting 5 months after the procedure. There was no reported mortality related to the endoscopic colloid cyst removal. The reported morbidities were hemiparesis in 2 cases, transient memory deficit in 7 patients, superficial wound infection in 5 patients, and CSF leakage from the wound in 3 cases. No recurrence was found in our series.Conclusions: Being a burr hole technique, endoscopy offers a real safe and effective minimally invasive tool for treating third ventricular colloids. It offers superior illumination, greater magnification, and enhanced visualizations of the ventricular anatomy. There is no doubt that the mortality, morbidity, and operative costs are less with endoscopy when compared with other combating therapeutic modalities. In our opinion, if the endless argument considering the point of tumor recurrence is brought apart, endoscopy should be the first-line treatment for third ventricular colloid cysts.www.neurosurgery-quarterly.com | 47 FIGURE 4. A, Computed tomography scan (axial view) showing third ventricular colloid cyst in a 21-year-old male patient. Partial cyst excision was made for this patient. B, CT scan (axial view) 6 months after surgery showing complete disappearance of the colloid cyst.We believe that this series did not add anything relevant to the technique by itself, and hence the relatively longer period of case follow-up without recurrence deserves to be examined. CONCLUSIONSEndoscopy, being a burr hole technique, offers a real safe and effective minimally invasive tool for treating third ventricular colloids. It offers superior illumination,...