Colloid Cyst Research Articles

Endoscopic Transcortical Tubular-Based Resection of a Third Ventricle Colloid Cyst: Two-Dimensional Operative Video.

ObjectiveThe objective of the study is to evaluate the safety, efficacy, and short-term outcomes of endoscopic excision of third-ventricular colloid cysts at a single tertiary care center in a resource-constrained environment.MethodologyA retrospective review was conducted at the Punjab Institute of Neurosciences, Lahore, from January 2022 to May 2024. The study included 22 patients identified from institutional records including the Picture Archiving and Communication System (PACS) comprising consecutive eligible individuals who underwent endoscopic excision during the study period.ResultsThe mean (standard deviation (SD)) age was 34.1 (15.0) years; 12 (54.5%) were female. Headache was the most common presenting symptom, followed by vomiting, drop attacks, and loss of consciousness. Complete excision was achieved in 19 (86.4%) patients. An external ventricular drain (EVD) was placed in 13 (59.1%) patients, and five (22.7%) required ventriculoperitoneal (VP) shunts (two preoperative and three postoperative). Postoperative complications included chemical meningitis in four (18.2%) patients and ventriculitis in two (9.1%) patients; overall, postoperative complications occurred in six (27.3%) patients. One death (4.5%) occurred. At six months, 20 patients completed follow-up; none reported recurrence of primary symptoms.ConclusionEndoscopic excision of third-ventricular colloid cysts was feasible in our series, with most patients achieving complete excision and favorable short-term outcomes. Complications and one mortality highlight the need for careful patient selection and standardized perioperative protocols. These results suggest that endoscopy can be a viable option in resource-limited settings, though longer follow-up and larger comparative studies are needed to confirm safety and long-term efficacy.

ABSTRACT Background This study develops the Modified Colloid Cyst Risk Score (MCCRS), a novel, evidence-based tool designed to identify patients with colloid cysts at high risk for clinical deterioration and obstructive hydrocephalus. Methods A systematic review was conducted to identify clinical indicators associated with worsening outcomes in colloid cyst patients. The MCCRS was constructed through expert consensus utilizing the modified Delphi technique. Its validity and reliability were subsequently evaluated. Results The review included 34 studies that met inclusion criteria. The MCCRS comprises several key criteria, each assigned specific points to stratify patients into different risk categories. These factors include cyst size (0–2 points), location within a risk zone (0–2 points), symptom presence (0–2 points), growth rate (0–2 points), patient age (0–1 point), and FLAIR MRI hyperintensity (additional point). Total scores categorize patients: 0–2 indicates low risk, suggesting annual MRI follow-up; 3–5 indicates moderate risk, requiring more frequent monitoring; scores of 6 or higher denote high risk, warranting aggressive management or surgical intervention. The MCCRS demonstrated a sensitivity of 93% and specificity of 99% for predicting clinical deterioration or obstructive hydrocephalus. Its positive predictive value was 98%, and negative predictive value was 94%. Conclusion The MCCRS is a valid, reliable tool that integrates multiple risk factors to guide clinical decision-making in colloid cyst management. It facilitates personalized monitoring strategies and intervention planning to prevent adverse outcomes.

BackgroundColloid cysts are rare, benign brain tumors often located in the third ventricle or near the foramen of Monro. They can evoke neuropsychiatric and physical symptoms including migraine, visual changes, memory loss, and sudden loss of consciousness. They are associated with high mortality due to late moderate-to-severe symptom presentation and limited access to neurological and/or neurosurgical expertise. The Colloid Cyst Symptoms Survey (CCSS) was designed and administered anonymously using REDCap and posted to the Colloid Cyst Survivors Facebook group for 6 months in 2022. The CCSS queried about sociodemographic factors, personal history of a colloid cyst, age of cyst diagnosis, neuropsychiatric and physical symptoms/signs before and after surgery, procedure type if their cyst was removed, and follow-up with neurological, neuropsychiatric or psychological services. Psychiatric symptoms within the last two weeks were assessed using the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult assessing 13 psychiatric domains (American Psychiatric Association).ResultsParticipants included 225 adults who were U.S citizens with a personal history of a colloid cyst. The majority were female (71.3%) and White (94.0%). Age of diagnosis occurred between 12 and 75 years old, median age 42 years. On average, patients reported 2 pre-clinical symptoms leading to diagnosis, most commonly migraine (48.9%) and aura (30.7%). Hydrocephalus was reported by 56.9%. In patients who underwent surgical removal of their colloid cyst, craniotomy (53.9%) was more common than endoscopic removal (42.6%). Common conditions and physical complications persisting after surgery included changes in energy level (N = 68), memory problems (N = 71), and anxiety (N = 46); higher prevalence of post-surgical complications were observed in the hydrocephalus and craniotomy groups. The DSM-5 screener identified areas of concern including memory, anxiety, somatic symptoms, sleep difficulties, anger, depressive symptoms, suicidality, and substance use. Despite this only ~ 1/10 patients received follow-up with psychiatrists or psychologists.ConclusionsTo our knowledge this is the largest cross-sectional study querying clinical characteristics among colloid cyst survivors. Persisting neuropsychiatric symptoms were reported to be high. People experiencing brain surgery, even for benign tumors, need to be assessed for neuropsychiatric morbidity.

Background/Objectives: Pituitary tumors account for over 90% of all sellar region masses. However, a spectrum of rare neoplastic, inflammatory, infectious, and vascular lesions-benign and malignant-can arise in the intra- and parasellar compartments and clinically and radiologically mimic PitNETs. We report a cohort of 47 such rare and cystic midline intracranial lesions, emphasizing their distinctive morphological, clinical, and imaging features and the personalized treatment strategies applied. Methods: In this retrospective single-center study, we reviewed all patients treated for suspected PitNETs via transsphenoidal approach between 2015 and 2024. Of 529 surgical cases, we excluded confirmed PitNETs, meningiomas, and classical intradural craniopharyngiomas. Collected data encompassed patient demographics, tumor characteristics, presenting symptoms, extent of resection or medical therapy, endocrine outcomes, and follow-up information. Results: Among all 529 patients who underwent surgical treatment for sellar lesions from 2015 to 2024, 47 cases (8.9%) were identified as rare or cystic masses. Forty-six underwent transsphenoidal resection; one patient with hypophysitis received corticosteroid therapy alone. Presenting symptoms included headache (n = 16), dizziness (n = 5), oculomotor disturbances (n = 2), and visual impairment (n = 17). Endocrine dysfunction was found in 30 patients, 27 of whom required hydrocortisone replacement. Histopathological diagnoses were led by colloid cysts (n = 14) and Rathke's cleft cysts (n = 11). The remaining 22 cases comprised plasmacytoma, germinoma, lymphoma, pituicytoma, inverted papilloma, metastatic carcinoma, chordoma, nasopharyngeal carcinoma, chloroma, and other rare entities. Preoperative imaging diagnosis proved incorrect in 38% (18/47) of cases, with several lesions initially misidentified as PitNETs. Conclusions: Nearly 9% of presumed PitNETs were rare, often benign or inflammatory lesions requiring distinct management. Most could be safely resected and demonstrated excellent long-term outcomes. Yet, despite advanced imaging techniques, accurate preoperative differentiation remains challenging, with over one-third misdiagnosed. Clinical red flags-such as early hormone deficits, rapid progression or atypical imaging findings-should prompt early interdisciplinary evaluation and, when indicated, image-guided biopsy to avoid unnecessary surgery and ensure tailored therapy.

Colloid cysts of the third ventricle are rare intracranial tumors that can cause increased intracranial pressure (ICP), leading to significant neurological symptoms. This study systematically reviews the surgical management, outcomes, and complications associated with colloid cysts in pediatric patients. A systematic review was conducted following PRISMA guidelines. Eligible studies reported on surgical interventions for colloid cysts in patients aged 0-18years. Data from nine studies were analyzed, covering 212 patients, with a mean age of 13.75years. Surgical techniques, clinical outcomes, complications, and follow-up data were synthesized narratively. Symptoms such as headache, vomiting, and seizures were common, with hydrocephalus frequently prompting surgical intervention. Endoscopic surgery was the preferred technique for smaller cysts, while open approaches, such as transcallosal and transcortical routes, were reserved for larger or more complex cases. Surgical outcomes were favorable, with minimal complications and low recurrence rates. However, follow-up protocols varied significantly, reflecting the absence of standardized guidelines. Geographically, Asia contributed the most studies, suggesting regional differences in prevalence or diagnostic practices. This review highlights current surgical practices in managing pediatric colloid cysts, with endoscopic resection frequently preferred for smaller or non-obstructive cysts. However, variability in follow-up protocols and regional practices underscores the need for standardized management pathways and further research.

Surgical resection of ventricular brain tumors is traditionally performed via microsurgery, which requires open craniotomy and can result in significant complications. Endoscopic approaches have emerged as minimally invasive alternatives. There is a lack of consensus regarding the preferred surgical strategy for ventricular tumor resection; the technique with the optimal rates of recurrence, mortality, and complications is debatable. This article aims to evaluate the efficacy of endoscopic resection in comparison to microsurgical resection, focusing on identifying the approach with superior clinical outcomes. To determine surgical outcomes, we performed a meta-analysis of the existing original studies across PubMed, SCOPUS, Cochrane, and Web of Science medical databases from inception to 20 February 2024, per PRISMA guidelines that discussed microsurgery and endoscopic resection in ventricular tumors. Eligible studies (n = 47) were included, which contained data describing clinical outcomes, postoperative complications, and mortality rates that were extracted and analyzed. A total of 47 studies, encompassing 3,059 patients (1,121 microsurgery, 1,938 endoscopy), were included. The mean age was 37.4 years (range 6-64), with 66.62% male (1,701/3,059). Colloid cysts were present in 67% (1,629/3,059), predominantly located in the third ventricle (55%, 715/1,301). Headache (96.15%, 2,700/2,808) was the most common symptom, followed by nausea/vomiting (12.5%, 351/2,808) and visual field deficits (11.26%, 316/2,808). The pooled gross-total resection (GTR) rate was 81.5% (95% CI, 75-88.1%; I²=66.66%), with endoscopic and microsurgery subgroups yielding GTR rates of 80% and 84.4%, respectively. Recurrence occurred in 4.7% (95% CI, 2.8-6.6%; I²=72.74%), with endoscopic and microsurgery rates of 3.9% and 6.6%. The mortality rate was 1.7% (95% CI, 0.9-2.5%; I²=29.1%), lower in endoscopic (0.6%) than microsurgery (5.2%). Postoperative hydrocephalus was noted in 4.8% (95% CI, 1.5-8.1%; I²=49.7%), cognitive deficits in 4.9% (95% CI, 3-6.9%; I²=33.57%), and cerebrospinal fluid leakage in 4.7% (95% CI, 1.8-7.6%; I²=53.81%). Seizures occurred in 3.6% (95% CI, 2-5.2%; I²=5.08%), neurological deficits in 5.5% (95% CI, 3-8%; I²=72.64%), visual field defects in 4.3% (95% CI, 2.6-6%; I²=35%), and wound infections in 2.5% (95% CI, 1-4%; I²=0%). Subgroup analyses generally showed lower complication rates for endoscopic surgery compared to microsurgery. Endoscopic resection offers favorable trends in the management of ventricular tumors. These include improved neurological outcomes, postoperative complications such as visual field defects and seizure rates, and lower mortality rates. Despite the need for further research to fully elucidate its benefits, Endoscopic resection stands out as a valuable technique in advancing neurosurgical care for ventricular tumor patients.

Understanding the prevalence, characteristics, diagnosis and management of headaches associated with neurocysticercosis (NCC) is essential for optimizing patient care. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We examined case reports, case series and cohort studies that explored headaches in NCC patients. The review protocol was registered in PROSPERO (CRD42024530164). A total of 53 isolated NCC cases presenting with headache and 8 cohort studies were included. Severe or progressive headaches, often resembling migraines, were most prevalent (35.2%). Brain parenchymal cysts were the most frequently observed lesion type (39.6%), followed by ventricular cysts (28.3%). Treatment primarily consisted of cysticidal therapy (66.2%), with surgical intervention required in 25.4% of cases. The majority of patients (96.2%) experienced clinical improvement. The meta-analysis addressed three key questions. Patients with primary headaches exhibited a significantly higher prevalence of calcified NCC (odds ratio [OR] 2.82, I2=0%). Likewise, primary headaches were more common in individuals with calcified NCC (OR 2.82, I2=0%). However, headache frequency (mean difference=1.93, I2=86%) and severity (mean difference=4.45, I2=99%) did not differ significantly. Brain parenchymal cysts, particularly ring or disk-enhancing colloidal cysts, may present with new-onset headaches mimicking primary headache syndromes. Our meta-analysis indicates a significant association between calcified NCC and primary headaches, but no substantial differences were found in headache frequency or severity.

Sudden deaths may result from many conditions which are either not apparent at autopsy or might be missed and such cases can be tricky as there is no definite cause of death. One such entity is Intracranial colloid cysts, they are congenital neuroepithelial cysts which might be missed or might rupture at the time of dissection. They typically arise within the third ventricle of the brain and can pose a significant risk of sudden death if left undiagnosed or untreated. These are rare entity and on cut-section, these cysts contain mucoid and gelatinous material. In this paper, we have discussed in depth about five cases of colloid cysts, most of which were brought dead to the hospital and were discovered during autopsy without any prior history suggesting the same.

Colloid cysts of the third ventricle are rare intracranial lesions, particularly uncommon in pediatric populations. Precise incidence figures in children remain uncertain, with existing data primarily derived from isolated case reports and limited case series. Pediatric colloid cysts generally present with a more aggressive clinical course, including hydrocephalus, increased intracranial pressure ICP, and even sudden death. Despite the low incidence, the high risk of life-threatening complications often necessitates surgical intervention. However, there is no consensus in the literature on the optimal surgical treatment for pediatric CCs, with microsurgical resection and endoscopic removal being the most commonly utilized methods. This meta-analysis aims to compare the efficacy and safety of microsurgical and endoscopic approaches for treating pediatric colloid cysts, focusing on surgical outcomes such as gross total resection (GTR), capsule removal, postoperative complications, the need for ventriculoperitoneal (VP) shunting, and recurrence rates. A systematic review and meta-analysis was conducted according to PRISMA guidelines. A comprehensive literature search was conducted to identify studies published between 2000 and Dicember 2024 on paediatric patients with colloid cysts. Statistical comparisons between the two surgical approaches were made based on key outcomes. Fifteen studies, comprising 249 pediatric cases, were included. The results showed no significant difference between the microsurgical and endoscopic approaches in terms of hydrocephalus at presentation (odds ratio [OR] = 0.9, p = 0.92), achieving GTR (OR = 0.9, p = 0.61) or capsule removal (OR = 0.9, p = 0.62). However, the microsurgical approach was associated with a significantly higher rate of postoperative complications (OR = 2.44, p = 0.01) and a higher likelihood of requiring a VP shunt (OR = 3.53, p = 0.04) compared to the endoscopic approach. There was no significant difference in recurrence rates between the two approaches (OR = 2.14, p = 0.37). Both microsurgical and endoscopic approaches achieve similar rates of GTR and capsule removal. However, the endoscopic approach is associated with fewer postoperative complications and a lower need for VP shunting. We believe that endoscopic resection of colloid cysts, when performed by an experienced neuroendoscopist, should be considered the standard approach for treating these lesions in the paediatric population. The investigation followed a prespecified protocol registered on PROSPERO (CRD420251018505).

This protocol describes a minimally invasive endoscopic technique for the removal of colloid cysts located in the third ventricle. These cysts are a rare type of intracranial lesion that can obstruct cerebrospinal fluid flow. If left untreated, they may cause hydrocephalus or, in severe cases, even sudden death. The objective of this approach is to provide a safe and effective alternative to traditional microsurgical methods. It does so by reducing postoperative pain, surgical morbidity, and hospital stays. The protocol delineates meticulous preoperative preparations, encompassing patient positioning and equipment setup, followed by a systematic step-by-step guide to the endoscopic surgical procedure. This protocol involves the use of intraoperative ultrasound guidance for precise navigation, incision of the cyst wall, aspiration of cyst contents, and meticulous hemostasis. Special care is taken to minimize damage to surrounding neural structures, ensuring complete cyst removal while reducing the risk of complications. The efficacy of this minimally invasive approach is substantiated by the observation that it is associated with reduced operation times, minimal neurological deficits, and rapid postoperative recovery. Typically, patients are able to resume mobilization the day after surgery and are discharged within two days. This protocol serves as a comprehensive guide for neurosurgeons aiming to enhance surgical precision while maximizing patient outcomes. The successful utilization of this protocol is dependent on meticulous preoperative planning, advanced intraoperative navigation techniques, and the employment of specialized endoscopic instruments.

ObjectiveDeeply located intracranial lesions such as intraparenchymal and intraventricular lesions are surgically challenging and associated with unavoidable complications such as seizure, surgical bed hematoma, and brain contusion caused by traction. The objective of this study is to evaluate the safety and effectiveness of the microscopic tubular retractor of a plastic syringe for the resection of deeply located brain lesions.Materials and MethodsWe retrospectively studied 157 patients with deep-seated intracranial lesions who underwent microscopic resection with the help of a tubular retractor made of a plastic syringe and Teflon introducer between January 2018 and January 2024 in a tertiary hospital. All deep-seated lesions were such as neurocytoma, lymphoma, ependymoma, colloid cysts, metastatic brain tumors, astrocytoma, and meningiomas. We evaluated all patients postoperatively with computed tomography (CT) scan on the first/second day of surgery. The amount of blood loss, the complications, and the mortality rate were recorded.ResultsThere were 104 males and 53 females with a mean age of 54.13 (range: 15–80) years. Gross total resection was obtained in 85.35% and subtotal in 14.65% of patients. Complications such as surgical bed hematoma in 5.73%, seizure in 3.18%, weakness in 2.54%, and contusion in 3.82% of patients were noted. The blood loss varied from 30 to 500 mL (average, 100 mL). The mortality rate was observed in 2.54% of all patients. Follow-up ranged from 1 to 25 months (average, 10 months).ConclusionPlastic syringe tubular retractor with Teflon introducer system is safe and effective for the treatment of deeply located intracranial lesions in terms of low morbidity and excellent rate of resection.

The selective estrogen receptor modulator clomiphene stimulates pituitary-derived gonadotropins to generate sex steroids including estrogen. Estrogen activates SOCS-3, which can inhibit growth hormone-directed JAK/STAT signaling to reduce serum insulin-like growth factor (IGF)-1 levels. We sought to examine the effects of clomiphene therapy on IGF-1 levels in nonacromegalic male patients treated with clomiphene for underlying hypogonadism. We identified 20 male subjects with hypogonadism treated with clomiphene citrate for at least 3 months. These patients were treated in an ambulatory, academic, tertiary medical center. The 20 male patients ranged from 27 to 76 years of age and hypogonadism was due to several etiologies, including prolactinomas, clinically nonfunctioning pituitary tumors, Rathke cleft cysts, colloid cysts, or idiopathic causes. Clomiphene citrate 50 mg 3 days per week was administered for a minimum of 3 months. IGF-1 was measured by liquid chromatography-mass spectroscopy before and after clomiphene therapy. Fifteen of 20 (75%) of hypogonadal men treated with clomiphene exhibited a decrease in median (IQR) serum IGF-1 levels of -0.60 (-1.2-0.0) (P < .01). Two of the 20 patients (10%) exhibited a decrease in IGF-1 >2 SD below their age- and sex-matched mean value. Clomiphene therapy can result in a significant reduction in serum IGF-1 levels in some treated hypogonadal men. Given that the decrease in IGF-1 can be >2 SD in some patients and potentially clinically significant, we recommend interval monitoring of serum IGF-1 levels and symptoms of growth hormone deficiency in patients with hypogonadism treated with clomiphene citrate.

Tailored Callosotomy in Third Ventricle Colloid Cyst Resection via Anterior Interhemispheric Transcallosal Approach.

Comparative Outcomes of Transcallosal Microsurgical and Endoscopic Transcortical Approaches for Colloid Cyst Removal: A Single-Center Retrospective Analysis

Rosette-Forming Glioneuronal Tumor Mimicking Foramen Monro Colloid Cyst: Case Presentation and Systematic Literature Review.

Third ventricle colloid cysts are benign lesions that can result in obstructive hydrocephalus with accompanying headache and loss of consciousness. In rare cases, colloid cysts can cause sudden, unexpected death. Colloid cysts are most often discovered as an incidental finding on CT or MRI of the head, without the patient having clinical signs of hydrocephalus.

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

Minimally Invasive Colloid Cyst Resection with Expandable Tubular Retractor for Small Ventricular Systems: Morphometric Analysis in Four Cadaveric Specimens

Resection of colloid cysts, a rare third ventricle pathology, is accepted clinical practice. Owing to their location proximal to deep gray nuclei and forniceal columns, colloid cysts have been theorized to contribute to cognitive decline. Comprehensive pre- and post-operative cognitive testing, however, has rarely been implemented. We analyzed formal neuropsychological testing performed in 20 patients undergoing endoscopic cyst resection. Pre- and post-operative performance was compared either for each individual patient or according to aggregated neuropsychological factor scores grouped via expert census. A change in performance was deemed significant if (i) it reached statistical significance and (ii) was greater than 1.5 pre-operative standard deviations. Twenty patients with colloid cysts (average diameter 13.3 ± 1.3 mm) underwent matched pre- and post-operative testing. No patient had a significant change in cognitive performance. Neurocognitive metrics assessing cognitive functions typically subsumed by the temporal (p = 0.35), extratemporal (p = 0.20), occipitoparietal (p = 0.31), or frontal lobes (p = 0.11) did not change post-operatively. Similarly, no differences emerged when factor scores were generated according to composite scores of different neurocognitive domains: attention (p = 0.32), executive function (p = 0.14), language (p = 0.98), and visuospatial function (p = 0.42). Neuropsychological testing allows for the careful monitoring of cognitive status before and after surgery and for the identification of patients who may benefit from pre- and post-operative cognitive rehabilitation. It should also be used as a valuable surgical psychometric marker and adjuvant. No significant cognitive decline was observed in this cohort.