Third ventricle colloid cysts: a consecutive 12-year series

Abstract

A continuous follow-up review of colloid cysts including aspects of natural history and evaluation of treatment options is necessary to optimize individual treatment. Thirty-seven consecutive patients with colloid cyst of the third ventricle seen at Karolinska Hospital between 1984 and 1995 were reviewed. Five patients were admitted in a comatose state, and two died despite emergency ventriculostomy. Three had recurrent cysts following previous aspiration procedure. During the study period, patients underwent a total of 10 ventriculostomies, 10 aspirations, 26 microsurgical operations, and two shunt operations. Twenty-four of 26 microsurgical operations were transcallosal and two were transcortical. Twenty-four operations (22 transcallosal and two transfrontal approaches) without permanent morbidity were performed by four surgeons. Transient memory deficit from forniceal traction was noted in 26%. The remaining two transcallosal operations, which led to permanent morbidity or mortality, were performed by two different surgeons. Aspiration of cysts performed by four different surgeons carried a 40% risk of transient memory deficit (10% permanent) and an 80% recurrence rate. One patient was found to be cured on radiological studies obtained at the 5-year follow-up review. Seven cysts were followed by means of radiological studies with no treatment for 6 to 37 months. Five of these cysts grew, indicating that younger patients with colloid cysts will probably need surgical treatment. The main causes of unfavorable results were: 1) failure to investigate symptoms that proved fatal; 2) subtotal resection; and 3) surgical complications. Transcallosal microsurgery produced excellent results when performed by experienced surgeons. A colloid cyst of the foramen of Monro is a disease that should be detected before permanent neurological damage has occurred. Permanent morbidity or mortality should not be accepted in modern series of third ventricle colloid cysts.

Endoscopic Versus Microsurgical Resection of Third Ventricle Colloid Cysts

“…However, microsurgical resection is associated with significant morbidity and prolonged post-operative hospital stays. 2,[20][21][22][23][24][25][26][27][28] More recently, some authors have reported less invasive microsurgical techniques with endoscopic assistance, 22 neuronavigation 29 and approaches through cylindrical retractors using stereotactic frames. 30,31 Although potentially less invasive, stereotactic aspiration is associated with recurrence rates of 30-80% [32][33][34] with recurrences occurring as early as two months in half of these.…”

Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts

“…1,11 Open surgery is traditionally considered the gold standard for the treatment of third ventricle colloid cysts, with many authors having reported a residual/recurrence rate ranging from 0% to 1.1% when using a transcallosal or transfrontal-transventricular approach. 5,6,8,10,13,18,19,26 How ever, these approaches have high operative morbidity and mortality rates because they are potentially associated with disabling complications such as venous infarction, hemiparesis, memory deficit, subdural hematoma, meningitis, and ventriculitis. 5,6,13,19,26 Taking these results into consideration, alternative options for the treatment of these lesions were investigated.…”

“…[2][3][4]6,[8][9][10]12,14,16,17,[19][20][21]23,28,29,31,32 Several series have demonstrated the efficacy and safety of endoscopic resection of colloid cysts with shorter operating times, shorter hospitalization, and fewer complications compared with open surgery. 5,18,26,29 Although the endoscopic treatment of third ventricle colloid cyst has progressively increased in recent years, its surgical results are still discussed because the rate of residual and recurrent cysts is higher than that of microsurgery.…”

Colloid Cyst Of Brain

“…It is supposed to be a vestigial structure of paraphysis. 7 In one study 8 , 58 symptomatic patients were followed for a mean period of 79 months. The results showed no incidence of symptoms upto 5 years and 8% incidence of symptoms upto 10 years suggesting that the lesion can be monitored safely.…”