Technical nuance

Abstract

Background. Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to go for complete endoscopic surgery using mainly aspiration, manipulation and coagulation with complete capsule resection and discuss the rationale for the procedure. Methods and materials. A case report with a third ventricle colloid cyst was surgically treated with a complete endoscopic excision using the proper technique. Results. Our patient underwent Transforaminal endoscopic surgery and the cyst was excised completely and the capsule was removed intentionally. Cyst remnants were absent on postoperative MRI. Mild Intraventricular haemorrhage was an intraoperative complication. Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications postoperatively. Follow-up did not show any recurrence or remnant growth that needed further treatment. Conclusion. Gross total resection may be the main objective for selected cases and seems to be safer while preserving good results, especially in a limited resource environment. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings. Full-endoscopic approach for third ventricle colloid cyst removal is a feasible technique. Cyst aspiration followed by grasping and rotational manoeuvre for the cyst wall provides total removal with the resolution of the obstruction if present and relief of symptoms.