Endoscopic versus Microsurgical Resection of Third Ventricle Colloid Cysts: A Single-Center Case Series of 140 Consecutive Patients

Abstract

Both endoscopic and microsurgery trans-cortical resection methods are used for colloid cysts of third ventricle but they are not compared to each other in regard to benefits and pitfalls. Data of patients who underwent surgical resection of third ventricle colloid cyst via either endoscopic or microsurgery approach by a single surgeon from 2005 to 2020 were retrospectively collected. After administration of criteria, 140 records were retrieved (60 patients through endoscopic resection and 80 patients by trans-cranial microsurgery approach). Clinical and surgical measures were compared between the two types of surgery after adjustment for confounders. Length of hospital stay, postoperative meningitis, and operation time, cyst size, and baseline comorbidities was similar between groups. Gross total resection (GTR) was achieved for all cases in microsurgery group while in endoscopic group it was lower (90% vs 100%; p=0.005). Intraoperative hemorrhage occurred in 14 (23.3%) of endoscopic patients while for microscopic group it was zero (p<0.001). Post-operative shunt was required for two patients (one in endoscopic group and the other in microscopic group). Two patients had tumor recurrence, both being in endoscopic group. No mortality was detected in either group. Multivariate analyses were insignificant for confounding effects of clinical and demographic factors in occurrence of worse surgical outcomes (non-GTR and hemorrhage). In our series the rate of intra-operative hemorrhage was higher in endoscopic method and GTR was lower, even after adjustment for other factors. This could be due to technologic shortcomings and limited space for resection maneuvers and complication management.