Microsurgical Excision of Colloid Cyst With Favorable Cognitive Outcomes and Short Operative Time and Hospital Stay

Sampath, Raghuram; Vannemreddy, Prasad; Nanda, Anil

doi:10.1227/01.neu.0000363858.17782.82

Cited by 46 publications

(34 citation statements)

References 32 publications

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“…Although colloid cysts are histologically benign lesions, their location deep within the brain, in association with the fornix, presents significant risk of major complications during surgical removal, approaching 15% on average. 18 Interestingly, in the present study, no patient with an incidentally discovered, asymptomatic colloid cyst of the third ventricle experienced acute obstructive hydrocephalus, sudden neurological deterioration, or death. Five patients (8.8%) followed with serial neuroimaging demonstrated radiological and/or symptomatic progression; 2 of which underwent urgent surgical excision due to new ventriculomegaly, whereas the remaining 3 underwent surgery on an elective basis.…”

Section: Discussionmentioning

confidence: 38%

Natural history of colloid cysts of the third ventricle

Beaumont¹,

Limbrick²,

Rich³

et al. 2016

JNS

101

105

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C olloid cysts of the third ventricle are rare, histologically benign lesions that occur in the region of the foramen of Monro, where they may cause obstructive hydrocephalus, rapid clinical deterioration, and death.The incidence of this lesion has been estimated at 3.2 per million per year, accounting for approximately 2% of all intracranial tumors. 8 Reliably defining the natural history of colloid cysts has been challenging due to their low inabbreviations AUC = area under the curve; CCRS = Colloid Cyst Risk Score; RR = relative risk. obJective Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. MethoDs The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-prediction model was defined using bootstrapped logistic regression. Predictive factors were then combined into a simple 5-point clinical scale referred to as the Colloid Cyst Risk Score (CCRS), and this was evaluated with receiver-operator characteristics. resUlts The study included 163 colloid cysts, more than half of which were discovered incidentally. More than half of the incidental cysts (58%) were followed with surveillance neuroimaging (mean follow-up 5.1 years). Five patients with incidental cysts (8.8%) progressed and underwent resection. No patient with an incidental, asymptomatic colloid cyst experienced acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly half (46.2%) of symptomatic patients presented with hydrocephalus. Eight patients (12.3%) presented acutely, and there were 2 deaths due to obstructive hydrocephalus and herniation. The authors identified several factors that were strongly correlated with the 2 outcome variables and defined third ventricle risk zones where colloid cysts can cause obstructive hydrocephalus. No patient with a lesion outside these risk zones presented with obstructive hydrocephalus. The CCRS had significant predictive capacity for symptomatic clinical status (area under the curve [AUC] 0.917) and obstructive hydrocephalus (AUC 0.845). A CCRS ≥ 4 was significantly associated with obstructive hydrocephalus (p < 0.0001, RR 19.4). conclUsions Patients with incidentally discovered colloid cysts can experi...

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Section: Discussionmentioning

confidence: 38%

Natural history of colloid cysts of the third ventricle

Beaumont¹,

Limbrick²,

Rich³

et al. 2016

JNS

101

105

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“…The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance. Good long-term cognitive performance can be achieved with 1 cm or less callosal incision along with the meticulous dissection around the fornix in microsurgical approach (47). Results in terms of operative times and postoperative stay can be comparable to endoscopic technique.…”

Section: Microscopic Transcallosal Approachmentioning

confidence: 97%

Management of colloid cyst of third ventricle

Yadav

Yadav²,

Parihar³

et al. 2014

Turkish Neurosurgery

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Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic for long time while some can present with paroxysmal headache, gait disturbance, nausea, vomiting, behavioral changes, weaknesses of lower limbs, impaired memory, new learning disability and sudden death. Computed tomography usually reveals a well-defined round or oval nonenhancing lesion. Although magnetic resonance imaging (MRI) signal intensity of colloid cysts is variable, the most common appearance is hyperintensity in T1-weighted sequences and iso to hypointensity in T2-weighted sequences. Observation, stereotactic aspiration, microscopic or endoscopic approaches and shunt surgery are various management options. Transcallosal and transcortical microscopic (with or without tubular retractor) approaches are mainly useful in normal-sized and dilated ventricles respectively. Endoscopic technique is an effective alternative to microsurgical technique but total resection and long-term recurrence remains a concern. Utilization of two instruments, the bi port technique and tubular retractor can be helpful in selected patients to overcome limitations. Although total excision should be aimed, subtotal excision and coagulation of residual cyst wall usually results in good long-term results without any growth of remnant wall. Conversion to an open procedure may be required in some patients.KEywords: Central nervous system cyst, Central nervous system neoplasm, Colloid cyst, Nervous system diseases, Third ventricle ÖZKolloid kistler genellikle üçüncü ventrikülde bulunur ve primitif nöroepitel veya endodermden köken aldıklarına inanılmaktadır. Hastalar uzun süre belirtisiz kalabilirler veya durum paroksismal baş ağrısı, yürüme bozukluğu, bulantı, kusma, davranış değişiklikleri, alt ekstremitelerde kuvvetsizlik, hafıza kaybı, yeni şeyler öğrenme zorluğu ve ani ölümle ortaya çıkabilir. Bilgisayarlı tomografi genellikle iyi tanımlanmış yuvarlak veya oval, kontrast tutmayan bir lezyon gösterir. Kolloid kistlerin manyetik rezonans görüntüleme (MRG) sinyal şiddeti değişkendir ama en sık rastlanan görünüm T1 ağırlıklı dizilerde hiperintens ve T2 ağırlıklı dizilerde izo ila hipointenstir. Gözlem, stereotaktik aspirasyon, mikroskopik veya endoskopik yaklaşımlar ve şant cerrahisi çeşitli tedavi seçenekleridir. Transkallosal ve transkortikal mikroskopik (tübüler retraktörle veya olmadan) yaklaşımlar temel olarak sırasıyla normal büyüklükte ve dilate ventriküllerde faydalıdır. Endoskopik teknik, mikrocerrahi tekniğe etkin bir alternatiftir ama total rezeksiyon imkanı ve uzun dönemde nüks olasılığı endişe yaratmaya devam etmektedir. İki alet kullanımı, iki portlu teknik ve tübüler retraktör bazı hastalarda sınırlamaları aşmak açısından faydalı olabilir. Total eksizyon hedeflenmelidir ama subtotal eksizyon ve kalan kist duvarının eksizyonu genellikle kalan duvarda bir büyüme olmadan uzun dönemli iyi sonuçlar verir. Bazı hastalarda açık cerrahiye dönmek de gerek...

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“…Short operation period, well total resection ratio, and minimum morbidity rate are benefits of this approach (13). There is a low possibility of disconnection syndrome and behavioral disorder occurrence as a result of the anterior callosotomy limited to a callosal incision smaller than 1 cm (14). In our study, 53.8% (7 cases) of 13 cases having microscopic surgery had surgical cystectomy through transcallosal approach.…”

Section: Discussionmentioning

confidence: 61%

Colloid cyst of the third ventricle: a clinical series of 19-cases

Bilgin¹,

Çavuş²,

Açık³

et al. 2017

J Turgut Ozal Med Cent

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Aim: Colloid cysts are benign tumors originating from primitive neuroepithelial or endodermic origin in the third ventricle. Asymptomatic, as well as paroxysmal headache, gait disturbance, nausea, vomiting, learning difficulty and death may occur. Computed tomography (CT) is also seen as a round or oval, non-contrasting lesion. Magnetic resonance imaging (MRI) also shows hyperintense at T1 weighed and isointens at T2 weighed sequences. Stereotactic aspiration, microscopic or endoscopic approaches, shunt can be applied. Total excision should be targeted. Material and Methods: We aimed to investigate the age, sex, complaint, hydrocephalus presence, neurological examination findings, surgical method and results of 19 cases of colloid cyst in our clinic between 2012-2017. Results: Eleven of 19 cases were female (57.9%) and 8 were male (42.1%).The average age was 27.2 (2-62). The most common complaint was headache. Ptosis due to visual disturbance was seen in 5.3% (1 patient), ataxia in 10.5% (2 patients), hydrocephalus with memory loss in 31.5% (6 patients). Six patients underwent cystectomy with endoscopic third ventriculostomy (ETV) and transcranial surgery in 13 patients. Ventriculoperitoneal shunt was performed to one patient at eight months after surgery. Rhinorrhea and menengitis was seen in one patient. Medical theraphy was given to this patient. One patient died because of acute cerebral anfarct. Conclusion: Asymptomatic old patients must be followed periodically. Symptomatic patients must be treated surgıcally and it must be combined by V-P shunt if patients had hydrocephalus. One of the surgıcal endoscopic or transcranial technics can be selected. Transcortical or interhemispheric technic may be preferred from transcranial technics.

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Microsurgical Excision of Colloid Cyst With Favorable Cognitive Outcomes and Short Operative Time and Hospital Stay

Cited by 46 publications

References 32 publications

Natural history of colloid cysts of the third ventricle

Natural history of colloid cysts of the third ventricle

Management of colloid cyst of third ventricle

Colloid cyst of the third ventricle: a clinical series of 19-cases

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