Endoscopic treatment of thalamic neuroepithelial cysts

Schmidt, Kelly; Coimbra, Caetano

doi:10.3171/jns.2005.103.2.0342

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…There is a relation between the patients' age and the pathological grade of thalamic lesions: they are usually malignant in adults with limited possibility of radical removal, while they are often benign in children and could be removed totally with better outcome [4][5][6]. Thalamic space-occupying lesions (SOL) include different pathological types as different grades of gliomas, lymphomas, metastasis, pyogenic abscesses, arteriovenous malformations, cavernomas, and thalamic neuroepithelial cysts [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Different strategies in the management of thalamic space-occupying lesions

Fayed¹,

Aziz²,

Eshra³

2020

Egypt J Neurosurg

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Introduction: Thalamic space-occupying lesions (SOL) are considered challenging for microsurgical removal. Unfortunately, the pathological features of lesions occurring in the thalamic region are different with a wide variation in clinical behavior and outcome. Although microsurgery is still the gold standard in the management of these lesions through different approaches, questions remain whether surgery is feasible and safe in these patients and what are the alternatives? It is well known that stereotactic techniques may be favorable especially in cystic, small, multiple lesions and in combination with adjuvant therapy. Transventricular endoscopic approach is also an alternative technique to combine tumor biopsy and treatment of hydrocephalus. Aim of the study: The identification of the different procedures for the management of thalamic SOL in respect to the age of the patient, the clinical condition, and the site of the lesion as well as its extent and pathology. Patients and methods: This prospective study included 35 patients having thalamic lesions with a mean age of 27 years old who were treated with different approaches including microsurgical, stereotactic, and endoscopic approaches. The clinical outcome was assessed as the same, improved, deteriorated, or died in comparison to the initial clinical status, while the radiological control was measured as no gross residual, residual < 10% and residual > 10%. Chi-square test was used to test the association between two categorical variables. Results: Thirty-five patients were included in this study, 20 were males and 15 were females. Eight cases were children, and 27 cases were adults. The most common clinical presentation was contralateral hemiparesis. The most common pathology was pilocytic astrocytoma. Radiological studies showed that the total thalamic type was the most common topographic variant and that 10 cases had hydrocephalus treated with CSF diversion procedures. For the definitive lesion, 2 cases underwent endoscopic biopsy and cystoventriculostomy and 18 cases had stereotactic technique in the form of biopsy, aspiration, and ommaya reservoir application, while 15 cases had microsurgery through different approaches with stereotactic technique preceding surgery in 2 of them. Conclusion: The main factors involved in choosing the appropriate approach included nature of the lesion (solid or cystic, multiplicity), suspected pathological type, and diffusion tensor imaging. Abscesses are best treated with stereotaxy, while non-neoplastic cystic lesions (other than abscesses) related to the ventricles are best treated with endoscopy. For the remaining pathologies, maximum surgical removal is the best management. Best lesion control was provided by microsurgery.

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Section: Introductionmentioning

confidence: 99%

“…Medial or dorsal thalamic lesions protruding in the ventricular system have a greater probability of causing obstructive hydrocephalus. Presentation with sensory deficits is unusual [3,10].…”

Section: Introductionmentioning

confidence: 99%

Different strategies in the management of thalamic space-occupying lesions

Fayed¹,

Aziz²,

Eshra³

2020

Egypt J Neurosurg

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“…Rarely, they are located in the posterior fossa or brainstem, or adjacent to the fourth ventricle. 16 Depending on their size and location, these lesions can cause hypothalamic dysfunction and obstructive hydrocephalus by AbbreviAtioNs b-FFE = balanced-fast field echo; DRIVE = driven-equilibrium; EMA = epithelial membrane antigen; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; GFAP = glial fibrillary acidic protein; SSFP = steady-state free precession; TSE = turbo spin echo; WBC = white blood cell; WISC-R = Wechsler Intelligence Scale for Children-revised. MethoDs This study reports the authors' experience with 5 patients affected by intraventricular cysts originating from the choroid plexus.…”

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confidence: 99%

“…The wide range of surgical options has included stereotactic aspiration, positioning of a cystosubarachnoid or cystoventricular shunt, external drainage via a reservoir system, microsurgical cyst resection and/or fenestration, and eventually endoscopic cyst fenestration into an adjacent subarachnoid or ventricular space. 16 Considering the variety of symptoms that these cysts can display at their clinical onset, the difficulty of obtaining an early and exact radiological diagnosis, and the wide spectrum of surgical alternatives proposed, choroid plexus cysts effectively constitute a significant clinical, radiological, and surgical challenge.…”

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confidence: 99%

Acute triventricular hydrocephalus caused by choroid plexus cysts: a diagnostic and neurosurgical challenge

Spennato¹,

Chiaramonte²,

Cicala

et al. 2016

FOC

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OBJECTIVE Intraventricular choroid plexus cysts are unusual causes of acute hydrocephalus in children. Radiological diagnosis of intraventricular choroid plexus cysts is difficult because they have very thin walls and fluid contents similar to CSF and can go undetected on routine CT studies. METHODS This study reports the authors' experience with 5 patients affected by intraventricular cysts originating from the choroid plexus. All patients experienced acute presentation with rapid neurological deterioration, sometimes associated with hypothalamic dysfunction, and required urgent surgery. In 2 cases the symptoms were intermittent, with spontaneous remission and sudden clinical deteriorations, reflecting an intermittent obstruction of the CSF pathway. RESULTS Radiological diagnosis was difficult in these cases because a nonenhanced CT scan revealed only triventricular hydrocephalus, with slight lateral ventricle asymmetry in all cases. MRI with driven-equilibrium sequences and CT ventriculography (in 1 case) allowed the authors to accurately diagnose the intraventricular cysts that typically occupied the posterior part of the third ventricle, occluding the aqueduct and at least 1 foramen of Monro. The patients were managed by urgent implantation of an external ventricular drain in 1 case (followed by endoscopic surgery, after completing a diagnostic workup) and by urgent endoscopic surgery in 4 cases. Endoscopic surgery allowed the shrinkage and near-complete removal of the cysts in all cases. Use of neuronavigation and a laser were indispensable. All procedures were uneventful, resulting in restoration of normal neurological conditions. Long-term follow-up (> 2 years) was available for 2 patients, and no complications or recurrences occurred. CONCLUSIONS This case series emphasizes the necessity of an accurate and precise identification of the possible causes of triventricular hydrocephalus. Endoscopic surgery can be considered the ideal treatment of choroid plexus cysts in children.