Colloid Cyst Excision Research Articles

Colloid cyst of the third ventricle

Background: In the past, microsurgical resection was considered the gold standard treatment for colloid cysts. The endoscopic approach is gaining popularity and has been recognized as a safe and effective alternative to open surgery. Aims: To evaluate our results, safety and efficacy of the endoscopic approach Materials and methods: This retrospective study included seven patients with colloid cysts who underwent endoscopic resection between May 2020 and April 2022. Patient records, radiological images, and surgical notes were assessed. Follow-up data, including clinical and radiological details, were retrieved. Postoperative Computed tomography (CT) was performed, and magnetic resonance imaging (MRI) was performed in all patients. Result: Seven patients aged range 27-56 years 4 males and 3 females underwent endoscopic resection of the tumor during the study period. All patients presented with headaches. The mean diameter of the cyst was 10.6(range 8 -14mm), and the mean operating time was 126(range 100 -180 min). All patients underwent the single burr hole and single port technique. Six patients underwent transforaminal surgery and one patient underwent trans-septal corridor. GTR was achieved in six patients. One patient underwent near-total resection with coagulation of the capsule. None of the endoscopic procedures was converted to open resection. No patient had a recurrence, and the mean follow-up period was 24.3 (range 16 to 36 months). There were no deaths during the follow-up period. No residual cysts were observed on postoperative MRI in any patient. Conclusion: Endoscopic excision of colloid cysts is an effective and safe alternative method. Although the follow-up time was short, the residual cyst wall remained asymptomatic without any evidence of growth after near excision and coagulation of the wall.

In Reply to the Letter to the Editor Regarding “Endoscopic versus Open Microsurgical Excision of Colloid Cysts: A Comparative Analysis and State-of-the-Art Review of Neurosurgical Techniques”

In Reply to the Letter to the Editor Regarding “Endoscopic versus Open Microsurgical Excision of Colloid Cysts: A Comparative Analysis and State-of-the-Art Review of Neurosurgical Techniques”

Letter to the Editor Regarding “Endoscopic versus Open Microsurgical Excision of Colloid Cysts: A Comparative Analysis and State-of-the-Art Review of Neurosurgical Techniques”

Letter to the Editor Regarding “Endoscopic versus Open Microsurgical Excision of Colloid Cysts: A Comparative Analysis and State-of-the-Art Review of Neurosurgical Techniques”

Outcome of Initial 3 Years of Cranial Endoscopy at DG Khan Medical College and Teaching Hospital, Dera Ghazi Khan

With the evolution of surgical approaches, endoscopic skull base surgery has emerged as a suitable alternative to many other invasive methods. The aim of this study was to investigate the efficacy and outcome of cranial endoscopy in treating various neurosurgical intracranial pathologies in terms of procedural success and complications. This observational, prospective case series was conducted at the Department of Neurosurgery of DG Khan Medical College from November 2017 to October 2020. The study enrolled 74 patients with indications for cranial neuroendoscopy. Clinical examination was performed, and a detailed history of the disease was obtained. Follow-up was conducted in the outpatient department. The collected data were analyzed using statistical analysis software. Of 77 procedures performed, endoscopic third ventriculostomy, arachnoid cyst fenestration, septostomy, colloid cyst excision, endoscopic assisted ventricular catheter placement, and intraventricular tumor biopsy were performed in 53.3%, 18.2%, 10.4%, 7.8%, 6.5%, and 3.9% of patients. Aqueductal stenosis was identified as the most common cause of obstructive hydrocephalus. Seizures and cerebrospinal fluid leaks were the most commonly reported complications (12% and 8.1%, respectively). The observed mortality rate was 2.7%. Neuroendoscopic surgery has become safe and effective, as surgeon experience and learning have lowered the risk of complications, and offers a low-cost alternative intervention.

Excision of Colloid Cyst through Interhemispheric, Transcallosal, Transcavum, Interfornicial Approach

AbstractColloid cysts (CC) occur predominantly in the midline with majority involving roof of the third ventricle. In cases of cavum septum pellucidum (CSP), the surgeon can lose orientation when normal intraventricular structures are not encountered during surgery. We report a patient with CSP, who underwent right frontal parasagittal craniotomy, interhemispheric, transcallosal approach to reach the lesion. Lesion may not be seen in its usual location of foramen of Monroe, and entering the cavum may be confusing because no intraventricular landmarks will be seen. Excision of the cyst through the cavum usually requires interfornicial approach, and this structure must be separated gently to avoid injury.

Endoscopic versus Open Microsurgical Excision of Colloid Cysts: A Comparative Analysis and State-of-the-Art Review of Neurosurgical Techniques

The surgical approaches of colloid cysts commonly include endoscopy or open microsurgery. Each approach carries its own challenges, feasibility, and complications. The aim of the current study is to compare endoscopic versus open microsurgical excision of third ventricular colloid cysts. A retrospective cohort study was conducted to compare the surgical outcomes of endoscopic versus open microsurgical (transcortical-transventricular and transcallosal approaches) excision of colloid cyst of the third ventricle at a tertiary-care medical institute. All patients with a neuroradiologic diagnosis of colloid cyst who subsequently underwent surgical management between January 2003 and June 2020 were included. The neurologic outcome was assessed at the last follow-up visit. A total of 32 patients with colloid cysts were included in the study. The mean age was 35.8 ± 18.3 years (range, 4-75 years). Female patients slightly outnumbered male patients (n= 17; 53.1%). A total of 21 patients (65.6%) underwent endoscopic resection of the colloid cyst. Complications were encountered in 7 patients (endoscopic, n= 3; microsurgery, n= 4; P= 0.151). Recurrence was identified in 4 patients (endoscopic, n= 3; microsurgery, n= 1; P= 0.673). Most patients improved neurologically on follow-up visits to the clinic (endoscopic, n= 19; microsurgery, n= 9; P= 0.482). Both endoscopic and microsurgical approaches provide favorable surgical outcomes in colloid cyst resection. The complication rates between both approaches is statistically insignificant. The optimal surgical approach for colloid cyst resection remains controversial.

Endoscopic Transcortical Transventricular Colloid Cyst Excision — Our Experience

Background: Colloid cyst of the third ventricle is a tumour arising from the roof of the third ventricle at the foramen of Monro. Endoscopic excision of colloid cyst is well established technique. There is less morbidity in comparison to the microsurgical resection.
 Materials and method: Seven patients with colloid cyst were treated with endoscopic excision. Of these five were males and two were female patients. Age ranged thirty to fifty five years from a period from Jan 2016 to Mar 2019 in NINS&H.
 Results: Most patients had signs of raised intracranial pressure before surgery. Six patients needed post operative VP shunt. Some patients had contusion of the fornix but did not have any memory impairment. Five patients had remnant but there was no symptoms after surgery.
 Conclusion: Endoscopic excision of the colloid cyst is a good option. Total removal of the tumour is the goal but little remnant of the tumour attached to the tela choroidae is accepted. One year follow-up showed no recurrence of the cyst.
 Bang. J Neurosurgery 2020; 9(2): 94-98

Endoscopic surgical excision of third ventricular colloid cyst in upper Egypt: results of 2 years of practice

Background: Colloid cyst is a benign rare lesion that originates in the third ventricle. Headache, vomiting, visual deterioration, and memory deficits are the most common presenting symptoms. Endoscopic excision of colloid cyst is one of the recent advances in the field of minimally invasive neurosurgery. Aim: The aim was to assess the efficacy and safety of the endoscope for excision of the colloid cyst. Patients and methods: In this study, we review our experience in 14 patients who presented to us in two University Hospitals in south of Egypt in 2 years (2016 and 2017). The authors used LOTTA ventriculoscope with HOPKINS wide-angle straightforward telescope 6°. Results: Of fourteen patients, 13 (92.9%) improved completely postoperatively, and only one (7.1%) patient who had visual deterioration did not improve after surgery. Total to near-total excision was done in 11 (78.6%) patients, and evacuation of the cyst with partial excision was done in three (21.4%) patients. Conclusion: Endoscopic excision of third ventricular colloid cyst is a safe minimally invasive approach that can be used in patients who present with colloid cyst without the need to do cerebrospinal fluid diversion (shunt).

Endoscopic management of third ventricle colloid cysts, analysis of the technical nuances and the neuroendoscopic anatomy: A preliminary experience

Introduction: Endoscopic excision of colloid cysts a minimally invasive and highly effective technique in management of third ventricular colloid cyst. Materials and Methods: Clinical and radiological data of patients undergoing endoscopic colloid cyst excision were retrospectively analyzed in the period July 2017 to August 2018. Operative video were analyzed for the colloid cyst anatomy and the surgical technique used. Results: Five cases underwent endoscopic surgery during the study period. Three patients had dilated foramen, two patients had retroforaminal type and coapted type of morbid endoscopic anatomy. Gross total excision could be achieved in two patients, two patients had near total excision and one patient had partial excision who had intraventricular bleed which was managed. There was no mortality. All the patients return to their respective jobs postoperatively. Conclusion: Endoscopic excision is a safe and effective surgical technique for colloid cyst excision. The extent of excision depends on the experience of surgeon and the endoscopic anatomy of the colloid cyst. Keywords: Colloid CYST, Third Ventricle, Endoscopic, Neuroendoscopic excision

Endoscopic Versus Microscopic Transcallosal Excision of Colloid Cysts: A Systematic Review in the Era of Complete Endoscopic Excision

Transcallosal microscopic and endoscopic excisions are both well established approaches to colloid cyst resection; however, there has been no clear consensus regarding the favored approach. We performed a systematic review comparing the transcallosal microscopic and endoscopic transcortical approaches for colloid cyst excision. We performed a systematic review from 2000-2018 of patients undergoing colloid cyst excision via a microscopic transcallosal or endoscopic transcortical approach where the surgical intent was gross total resection. Studies that included multiple approaches were included if the reported results were stratified by approach. The microsurgical transcallosal approach had a higher rate of gross total resection when compared with endoscopic excision (96% for transcallosal vs. 78.5% endoscopic; P < 0.0001). There was also a lower recurrence rate with the transcallosal approach (0.98% vs. 2.16%; P= 0.0036); however, there was no difference in reoperation rates with similar length of follow-up (0.33% transcallosal, 0.61% endoscopic; P= 1.000). Endoscopy had lower overall morbidity when compared with transcallosal approaches (8.7% vs. 18.6%; P= 0.0001), including statistically significant lower rates of infection, infarct, and seizures in the endoscopic cohort. Rates of permanent memory deficit were similar (6.55% transcallosal vs. 4.5% endoscopic; P= 0.52). Shunt dependency was 9.8% after transcallosal excision versus 3.5% after endoscopic excision (P= 0.0002). Modern series of colloid cyst excision continue to favor transcallosal approaches in achieving gross total resection. Nevertheless, endoscopic techniques have significantly reduced morbidity compared to transcallosal approaches, including lower rates of infection, infarct, and seizure. Endoscopic approaches also have a statistically significant decreased rate of shunt dependency-arguably the most important primary endpoint of surgery. With improving endoscopic technology and mastery of the technique, endoscopic excision is maturing into a standard first-line approach for colloid cyst excision.

Efficacy and Safety of the Rotational Technique for Endoscopic Transforaminal Excision of Colloid Cysts of the Third Ventricle

The main criticism of endoscopic excision of colloid cysts of the third ventricle is the decreased ability to completely resect the cyst wall, therefore increasing the risk of recurrence. The extent of resection varies widely across the endoscopic series and is largely influenced by the surgical technique. We report the results of the rotational technique for endoscopic transforaminal excision of colloid cysts in a series of consecutive patients. Our objective is to contribute to the current literature and to shed more light on an effective and safe yet less commonly used technique. Retrospective analysis was performed on 19 patients. Preoperative magnetic resonance imaging (MRI) was evaluated for cyst characteristics. Postoperative MRI was evaluated for residual cyst membranes. Operative records were reviewed for residual cyst components. Excision grade was determined based on the Barrow Neurological Institute grading scale. Symptom resolution was documented clinically. The study included 13 men and 6 women, with a mean age of 35 years (range, 19-56 years) and mean follow-up of 27.74 months (range, 4-55 months). Total excision was achieved in 17 of 19 cysts (89.5%). A small residual was seen intraoperatively but not radiographically in 1 patient. In another patient, residual cyst membrane seen intraoperatively and radiologically led to recurrence 18 months postoperatively. No mortalities or permanent morbidities occurred. Our high total excision rate and low complication profile are in concordance with the recent reports of endoscopic resection of colloid cysts. The rotational technique for the endoscopic transforaminal approach is highly effective and a safe alternative to the bimanual dissection technique.

Surgical management of colloid cysts in children: experience at a tertiary care center.

Colloid cysts are uncommon lesions in the pediatric age group, which most commonly occur in the fourth through fifth decades. The authors hereby report a series of 36 patients with colloid cysts in the pediatric age group. A retrospective chart review was conducted on all patients with colloid cyst who underwent surgery in our institute between November 2003 and December 2016 (13years). Patients above the age of 18 were excluded from the study. They were analyzed based on clinical presentation, radiological findings, surgical approaches, and outcome. There were 36 pediatric patients selected for the study. Age ranged from 8 to 18years. The male-to-female ratio was 3.5:1. Headache and vomiting were the most common symptoms, and papilledema is the most common clinical sign. The mean duration of symptoms was 9months (range 1day to 5years), but 27 (75%) of the children had precipitous symptoms just before presentation. Preoperative CT showed a hyperdense non-enhancing lesion in the majority of cases. Endoscopic excision was done in 13; 5 patients underwent transcortical transventricular excision, while transcallosal approach was opted for in 17 patients. In one patient, the colloid cyst could not be removed endoscopically and had to be converted to transcortical transventricular approach. Postoperatively, five patients developed CSF leak. They were successfully managed conservatively. One patient had operative site extra dural hematoma and underwent re-exploration, and two patients had transient hemiparesis which improved spontaneously. The median follow-up period was 9months in the 30 available patients. Though no formal neuropsychological testing was done at follow-up, all children appeared to be doing well without memory disturbances. Pediatric colloid cysts are less common and may show rapid deterioration. Timely surgery results in a permanent cure with minimum morbidity. The results of either micro neurosurgical or endoscopic operative excision of colloid cysts in children are excellent. All children who are symptomatic with raised intracranial pressure due to a third ventricular colloid cyst should undergo definitive surgery. There were no major permanent deficits in memory or disconnection syndromes observed with the limited anterior colostomy.

Frame-Based Stereotactic-Guided Excision of Colloid Cyst of Cavum Septum Pellucidum through Transcallosal Approach—A Technical Note

AbstractColloid cyst is a rare benign intracranial lesion. Due to its embryologic origin and development, it is commonly located within the third ventricle, though it also presents at various locations. Its location within cavum septum pellucidum is rarely reported. Operative approaches to such lesion can be challenging and misleading due to intraoperative variations. However, surgical resection in such locations are simplified and perfected with stereotactic guidance. A case of colloid cyst within the cavum septum pellucidum and the importance of stereotactic guidance in precisely reaching the lesion, thus minimizing the dissection of corpus callosum, are discussed.

Microsurgical vs. Endoscopic Excision of Colloid Cysts: An Analysis of Complications and Costs Using a Longitudinal Administrative Database.

Open microsurgical and endoscopic approaches are the two main surgical options for excision of colloid cysts. Controversy remains as to which is superior. Previous studies consist of small cohort sizes. This topic has not been investigated using national administrative claims data which benefits from larger patient numbers. Current Procedural Terminology (CPT) and International Classification of Disease version 9 (ICD-9) coding at inpatient visit was used to select for index surgical procedures corresponding to microsurgical or endoscopic excision of colloid cysts. Comorbidities, costs, and complications were collected. We identified a total of 483 patients. In all, 240 were from the microsurgical cohort and 243 were from the endoscopic cohort. The two groups displayed similar demographic and comorbidity profiles. Thirty-day post-operative complications were also similar between groups with the exception of seizures and thirty-day readmissions, both higher in the open surgical cohort. The seizure rates were 14.7 and 5.4% in the microsurgical and endoscopic cohorts, respectively (p = 0.0011). The thirty-day readmission rates were 17.3 and 9.6% in the microsurgical and endoscopic cohorts, respectively (p = 0.0149). Index admission costs and 90-day post discharge payments were higher in patients receiving microsurgical excision. An analysis of administrative claims data revealed few differences in surgical complications following colloid cyst excision via microsurgical and endoscopic approaches. Post-operative seizures and thirty-day readmissions were seen at higher frequency in patients who underwent microsurgical resection. Despite similar complication profiles, patients undergoing microsurgical excision experienced higher index admission costs and 90-day aggregated costs suggesting that complications may have been more severe in this group.

Endoscopic colloid cyst excision: surgical techniques and nuances.

Endoscopic excision of colloid cysts is currently well established as a minimally invasive and highly effective technique that is associated with less morbidity in comparison to microsurgical resection. Operative charts and videos of patients undergoing endoscopic colloid cyst excision were retrieved from the senior author's database of endoscopic procedures and reviewed. This revealed nine trans-foraminal and three trans-septal procedures. Description of the surgical techniques was then formulated. Variation of the technique is based on the specific patho-anatomical features of the colloid cyst being resected. For the trans-foraminal approach, we think that the rotational technique is associated with a more complete removal of the cyst wall and consequently lower recurrence rate.

Colloid Cysts: Endoscopic or Microsurgical Resection?

The surgical approaches of colloid cysts commonly include endoscopy or open microsurgery. Each approach carries its own challenges, feasibility, and complications. The aim of the current study is to compare endoscopic versus open microsurgical excision of third ventricular colloid cysts.A retrospective cohort study was conducted to compare the surgical outcomes of endoscopic versus open microsurgical (transcortical-transventricular and transcallosal approaches) excision of colloid cyst of the third ventricle at a tertiary-care medical institute. All patients with a neuroradiologic diagnosis of colloid cyst who subsequently underwent surgical management between January 2003 and June 2020 were included. The neurologic outcome was assessed at the last follow-up visit.A total of 32 patients with colloid cysts were included in the study. The mean age was 35.8 ± 18.3 years (range, 4–75 years). Female patients slightly outnumbered male patients (n = 17; 53.1%). A total of 21 patients (65.6%) underwent endoscopic resection of the colloid cyst. Complications were encountered in 7 patients (endoscopic, n = 3; microsurgery, n = 4; P = 0.151). Recurrence was identified in 4 patients (endoscopic, n = 3; microsurgery, n = 1; P = 0.673). Most patients improved neurologically on follow-up visits to the clinic (endoscopic, n = 19; microsurgery, n = 9; P = 0.482).Both endoscopic and microsurgical approaches provide favorable surgical outcomes in colloid cyst resection. The complication rates between both approaches is statistically insignificant. The optimal surgical approach for colloid cyst resection remains controversial.

Operative nuances of excision of colloid cysts in septum pellucidum: A report of three cases

Colloid cysts are common cysts are often located in the anterior third ventricle and septum pellucidum location is extremely rare. Cysts in septum pellucidum can be missed at surgery because of their unusual location. We describe three patients with colloid cysts in the septum pellucidum, with two in the cavum septum pellucidum. Various surgical implications of this unusual location are enumerated.

Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study

Different management options are available for the treatment of colloid cysts. Goals of those procedures are to achieve a complete resection avoiding potential long-term recurrence along with CSF pathways restoration with minimal morbidity and mortality. The two main surgical options are endoscopic resection or direct removal by either transfrontal or transcallosal approach. The efficacy of endoscopic technique to achieve gross total colloid cyst excision has been well documented. In the present study, authors describe a series of 29 patients who underwent surgery by a variation of the standard worldwide implemented endoscopic technique. Using a more anterior approach, it is easier to reach the roof of the cyst, its possible adherences with the tela choroidea, plexus, and the internal cerebral veins. The described approach has shown to be safe, quick, and very effective with a total cyst removal rate of 86.2%.

Hemorrhagic colloid cyst: Case report and review of the literature

Colloid cysts are cystic lesions located at the anterior part of third ventricle, close to foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is very rare. On literature review, we found only six cases of hemorrgic colloid cyst; among them, four were diagnosed at postmortem examination. We report a rare case of a hemorrhagic colloid cyst in a young lady who presented with sudden onset severe headache and vomiting. Computed tomography (CT) scan showed isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. The lesion was not enhancing on contrast. Magnetic resonance imaging (MRI) brain revealed a well-defined cystic mass lesion located at the foramen of Monro which was hyperintense on T1 and hypointense on T2-weighted images. Excision of the colloid cyst was performed which revealed hemorrhagic clot instead of colloid material. Histopathological examination revealed a colloid cyst with hemorrhage. We believe that this is the first such reported case of successful clinical outcome following early diagnosis and excision of a hemorrhagic colloid cyst in an adult.

COLLOID CYST OF THE THIRD VENTRICLE

Objectives: Cerebrospinal fluid shunting or microsurgical resection of the colloid cysts of the third ventricle have long been a standard treatment. The emergence of neuroendoscopy has lead to its application in various neurosurgical problems. Colloid cyst of the third ventricle is one such pathology where endoscopic treatment has been performed with great clinical success during the past decade. We now Although considered less efficacious than microsurgical excision endoscopic excision is less invasive and much simpler.Objectives: (1) to assess the extent of excision (2) to assess the morbid anatomy of the colloid cyst (3) to assess the risk of complications (4) to assess the functional outcome. Period: Eight years (Jul 2001-June 2009) Materials and Methods: Endoscopic resections of 15 colloid cysts of the third ventricle with obstruction of Foramina of Monroe in all cases. Results: Total removal was achieved in 10 (66.7%) cases. In 5 (33.3%) patients the colloid material was evacuated completely while the remnant of the capsule adherent to its origin was left behind. Two (13.3%) patients developed meningitis one week postoperatively and one diedsubsequently. Nine (60%) patients had excellent recovery as the symptoms were relieved during a period of 3 to 24 months. Five (33.3%) of the total patients required ventriculoperitoneal shunt for obstructivey drocephalus which developed with in 2 weeks after surgery. One out of the total number of patients deteriorated postoperatively on the existing neurological deficit. There has not been any recurrence until now with subtotal excision of the capsule. Conclusions: Keyhole surgery under endoscopic visual control offers an alternative, very effective minimally invasive approach for the excision of colloid cyst of the third ventricle and is likely to replace microsurgical resection as a standard procedure.