Sudden deterioration and death in patients with benign tumors of the third ventricle area

Abstract

Although sudden deterioration and death is a widely recognized complication in patients with benign tumors of the third ventricle area, the exact incidence of this dreaded occurrence is unknown and the reports in the literature on the subject are largely anecdotal. Neither risk factors nor the etiology of the sudden death have been analyzed. The vast majority of these benign tumors are colloid cysts, and the presence and degree of ventricular dilatation and herniation associated with these tumors as cited in the reports are quite variable. The authors report a case of sudden death in a 27-year-old woman with a subependymoma of the left lateral and third ventricles. A review of the literature is included in an attempt to discern identifiable risk factors for sudden death in patients with tumors of the third ventricle area. Since this potential complication is known to exist in patients with otherwise benign tumors amenable to surgical resection, the authors recommend either prompt removal of the tumor on discovery or close monitoring of the patient if surgery is to be delayed.

Natural history of colloid cysts of the third ventricle

“…Estimates of the risk of rapid clinical deterioration due to acute hydrocephalus in patients with colloid cysts vary widely, from 3% to 35%, with an associated 5%-38% risk of death. 2,4,12,13,17 Historically, these patients were often described as having experienced "sudden deterioration and death," but several more recent studies using modern neuroimaging techniques have demonstrated that nearly all patients with acute obstructive hydrocephalus have progressive symptoms preceding precipitous clinical deterioration. Potential exceptions are the rare instances of acute intralesional hemorrhage or "cyst apoplexy."…”

Spontaneous Rupture of a Presumed Colloid Cyst of the Third Ventricle. Case Report.

“…3,16) However, the number of patients with diagnoses of colloid cysts is likely to decrease with age. 6) With aging, colloid cyst cells secrete an amorphous, proteinaceous material resulting in cyst formation and expansion.…”

“…Prophylactic surgery for asymptomatic colloid cysts of the third ventricle remains controversial. 3,15,16) However, the possibility of spontaneous rupture of these cysts should also be kept in mind. If surgery is indicated, the surgical team must ensure that the cyst contents do not spill into the ventricular system.…”

“…11,16) Colloid cysts are histologically composed of cuboidal, columnar, or pseudostratified epithelial lining with interspersed mucous goblet cells. The epithelium rests on a thin layer of connective tissue.…”

Üçüncü ventrikül anterior yerleşimli benign lezyonlarda interhemisferik transkallozal transforaminal yaklaşım: olgu serisi

“…Sudden death has been linked to the proximity of cardiovascular centers to the third ventricle or to sudden-onset hydrocephaly 16 . The mechanism of drop attacks has been linked to transient CSF flow blockage; however, as Kelly also stressed, other symptoms are not specific for colloid cysts located in the third ventricle 15,16,17 . Total excision of colloid cysts is recommended in symptomatic cases since simple cyst aspiration is not sufficient 11 .…”