Endoscopic Versus Microsurgical Resection of Colloid Cysts: A Systematic Review and Meta-Analysis of 1278 Patients

Abstract

Colloid cysts of the third ventricle have been successfully treated with transcranial microsurgical approaches. However, the endoscopic approach has recently been advocated as a lesser invasive technique. We conducted a systematic review and meta-analysis of published studies to compare the outcomes between the two approaches. A PubMED search of contemporary literature (1990-2014) was performed to identify surgical series of open and endoscopic treatment of colloid cysts. Relevant articles were identified and data were extracted concerning surgical treatment, extent of resection, and outcomes. A meta-analysis was performed for recurrence rates based on treatment strategy. A total of 583 patients were included in the microsurgical group, and 695 patients in the endoscopic group. The microsurgical approach was found to have a significantly higher gross total resection rate (96.8% vs. 58.2%; P < 0.0001), lower recurrence rate (1.48% vs. 3.91%; P = 0.0003), and lower reoperation rate (0.38% vs. 3.0%; P = 0.0006) compared with the endoscopic group. There was no significant difference in mortality rate (1.4% vs. 0.6%) or shunt dependency (6.2% vs. 3.9%) between the two groups. The overall morbidity rate was lower in the endoscopic group (10.5%) than in the microsurgery group (16.3%). Within the microsurgery group, the transcallosal approach had a lower overall morbidity rate (14.4%) than the transcortical approach (24.5%). Microsurgical resection of colloid cysts is associated with a higher rate of complete resection, lower rate of recurrence, and fewer reoperations than with endoscopic removal. However, the rate of morbidity is higher with microsurgery than with endoscopy.