Recurrence following microsurgical excision of third ventricular colloid cysts in a contemporary cohort of 84 patients

Abstract

ObjectiveTo examine recurrence rates in patients undergoing microsurgical excision of colloid cysts of the third ventricle with long-term serial clinical and imaging follow up and to identify risk factors for cyst recurrence. MethodsIn this retrospective study, we analysed a single-surgeon cohort of 84 patients who underwent microsurgical excision of a third ventricular colloid cyst between 1994 and 2018 and who were followed for at least 12 months after surgery. The primary outcome of interest was recurrence (asymptomatic and symptomatic). ResultsThe mean age at surgery was 33.8 (range, 8-65 years). Out of 84 patients, 82 (97.6%) were symptomatic and 71 (84.5%) had obstructive hydrocephalus. The mean tumor size was 15.2 mm (range, 7-35 mm). A total or near total excision was achieved in 76 (90.5%) patients. The median clinical follow-up duration was 89.5 months (range, 12-340 months). 81 (96.4%) had follow up imaging. Overall, recurrence occurred in 25 (29.8%) cases, with 7 (8.3%) experiencing symptomatic recurrence. No specific risk factors for recurrence were identified. Longer follow-up was associated with a higher detection of recurrences. The 5-year recurrence free survival rate was 81.6%, which dropped to 66.5% at 10 years follow up. ConclusionPeriodic imaging surveillance is essential following excision of third ventricular colloid cysts to detect asymptomatic recurrences, as these lesions may recur several years after presumed total or near-total excision. Recurrences associated with clinical symptoms or demonstrated growth on serial follow-up require intervention; however, re-operation may be cautiously deferred in patients with stable asymptomatic recurrences.