Ventricle Colloid Cyst Research Articles

A clinical and neuropsychological study of patients before and after resection of third ventricle colloid cysts

To evaluate cognitive impairments in patients before and after resection of third ventricle colloid cysts. We performed a clinical and neuropsychological study of 52 patients with third ventricle colloid cysts using the Luria method (1962). Forty three patients were examined before and after cyst resection in the early postoperative period (three patients in this group were also examined in a long-term period of 3-7 months after surgery). Forty one patients were operated on using the transcallosal approach, and two patients were operated on using the subtentorial-supracerebellar transchoroidal approach. The other patients were examined only before or after surgery. The patients' age ranged from 14 to 61 years; the mean age was 33.8 years; the median age was 29 years. On examination before surgery, cognitive impairments were minimal in 5 patients without clear signs of hydrocephalus. Impairments of memory and dynamic praxis, mild spatial disorders, and psychological inertia were observed in other patients with hydrocephalus. There was no significant difference in the state of cognitive functions between patients with and without stagnation in the fundus. On examination on day 3-6 after transcallosal surgery, several groups of patients were identified. Eight patients had an improvement in cognitive functions, which might be related to postoperative resolution of hydrocephalus. In 15 patients, changes in mnestic functions were insignificant. This group consisted of the youngest patients with a median age of 24 years. Korsakoff syndrome and disorientation were detected in 5 patients. This was the oldest age group, with a median age of 48 years. In other 13 patients, aggravation of mnestic disorders was moderate. Similar memory impairments were detected in the case of the subtentorial-supracerebellar approach. Memory disorders progressively regressed in all patients. Postoperative memory impairment of a varying degree was found in 21 out of 43 patients, with adhesions between the cyst capsule and fornix being observed only in 5 patients. In this case, no injury to the fornix was intraoperatively observed. We discuss the role of the age factor, cyst size, and technical surgical difficulties in the pathogenesis of memory disorders in the absence of injury to the calvarium during colloid cyst resection.

Out-of-third ventricle colloid cysts: review of the literature on pathophysiology, diagnosis and treatment of an uncommon condition, with a focus on headache

Colloid cysts are rare benign intracranial lesions classically described as "third ventricle colloid cysts" because of their location within the third ventricle. These lesions' clinical and diagnostic features are mainly related to intermittent or persistent obstruction of foramina of Monro causing cerebrospinal fluid (CSF) circulation impairment and symptoms of raised intracranial pressure. Few reports on colloid cysts located outside the third ventricle have been published over the years. This paper aims to review the existing literature on out-of-third ventricle colloid cysts, and introduces a new illustrative case of lateral ventricle colloid cyst surgically managed with endoscopic technique. A literature review was performed through a Medline web-search, using "colloid cysts," "lateral ventricle colloid cysts," "fourth ventricle colloid cysts," "brain colloid cyst," "spinal colloid cysts" as keywords. All retrieved abstracts were screened and full-length text of papers suitable for inclusion were examined. An illustrative case has been added to the existing literature. A 45-year-old man complaining of recurrent headache underwent conservative treatment for 4 years. The unusual headache features as well as the uncommon onset and association with episodic mental impairment led to an initial diagnosis of anxiety disorder triggering the headache. A further worsening of headache and the lack of significant clinical benefit prompted further investigation. Computed-tomography (CT) of the brain showed asymmetrical dilatation of the right lateral ventricle, due to the presence of a cystic mass obstructing the foramen of Monroe. Patient underwent endoscopic resection of the cyst. The literature review revealed 16 papers reported between 1952 and 2016. In all cases included histological diagnosis of colloid cyst had been obtained. Clinical and radiological features, as well as surgical management in each case have been analyzed. In the case here reported, histological examination documented a colloid cyst. The postoperative course was uneventful, with progressive resolution of headache. Despite third ventricle colloid cysts are related to typical clinical and diagnostic features, non-third ventricle colloid cysts may be responsible for unusual clinical presentation, so making a correct diagnostic approach challenging. We submit that in cases of recurrent headache with unusual features and lacking signs of neurological deficits, a rare neurosurgical condition as an "ectopic" colloid cyst should be included in the differential diagnosis.

Occipital Lobe Infarction due to Acute Hydrocephalus Secondary to Third Ventricle Colloid Cyst in a Child

An 11-year-old boy presented with sudden onset of altered consciousness following acute-onset severe headache and vomiting. Computed tomography showed hydrocephalus due to obstruction of the foramen of Monro by an isodense mass in the anterior third ventricle. Ventriculoperitoneal shunt was placed to relieve the hydrocephalus and the patient improved clinically. Magnetic resonance imaging of the brain revealed a well-defined lesion with isointense signal intensity on T1-weighted and hyperintense signal intensity on T2-weighted images. Acute, right occipital lobe and right thalamic infarction was revealed by diffusion-weighted imaging; smaller infarct was seen in the medial left occipital lobe. Imaging findings were compatible with third ventricle colloid cyst causing acute hydrocephalus and occipital lobe infarction due to central transtentorial herniation.

Conversion technique from neuroendoscopy to microsurgery in ventricular tumors: Technical note.

Background:Ventricular tumors represent a major neurosurgical challenge, making endoscopic approach an invaluable tool as it gained importance due to technological advances. Nevertheless, the method is not exempt of risk and limitations, sometimes requiring an open surgery. Thus, initial measurements must be adopted in order to simplify an eventual need for conversion to open craniotomy.Methods:Here, we describe a series of 6 patients with ventricular tumors approached by neuroendoscopy where the conversion to microsurgery turned out to be necessary. Patients’ average age was 59.5 years (39–75 years). Average tumoral size was 17.8 mm (15–21 mm). There were 2 cases of lateral ventricle subependymoma and 4 cases of third ventricle colloid cysts. A standard surgical incision was performed in the coronal direction, allowing lateral expansion to 10 cm. Moreover, the endoscopic burr hole was enlarged to a 5 cm craniotomy. A small enlargement of the endoscopic cortical access was performed to gain a transcortical microsurgical corridor to the ventricular cavity. The need for conversion arose due to high consistency of the tumor (3 cases), technical problems (2 cases), and cortical collapse (1 case).Results:There was one case of cerebrospinal fluid fistula and infection and one case of transitory memory disturbance. In both the cases, we obtained a complete functional recovery. Clinical and radiological follow-up showed total tumor removal with no recurrences.Conclusions:The technique herein described was easy to perform, promptly bypassed the endoscopic limitations, and gathered excellent surgical results. The possibility of adapting the method to other tumor locations may be considered.

Endoscopic resection of colloid cyst: long-term followup with 65 patients

Introduction: Colloid cysts of the third ventricle are rare, histologically benign lesions that can be associated with obstructive hydrocephalus. Endoscopic removal developed as an alternative to microsurgical craniotomy as a less invasive surgical treatment. This review examines the endoscopic surgical experience for a consecutive series of patients with colloid cyst of the third ventricle. Methods: Patients with a diagnosis of “colloid cyst of the third ventricle” who were treated in Calgary between January 1994 and July 2014 were reviewed using a clinic database and registry. Results: 95 patients were identified. 30 patients without hydrocephalus underwent serial MRI and clinical observation with one patient developing hydrocephalus leading to surgical treatment. 65 patients underwent endoscopic treatment of their colloid cyst (male=34; female=31). The mean age at diagnosis was 45.5 years. 3 patients had been previously treated with other surgical approaches. All surgically treated patients had hydrocephalus and hydrocephalus resolved in all 65 patients. 1 patient sustained an injury to the internal capsule with transient hemiparesis. Mean followup was 8.2 years (range 0.1-19.3 years). 3 patients experienced colloid cyst recurrence treated with a second endoscopic removal. Conclusion: Endoscopic treatment of third ventricle colloid cysts can be performed with low risk as an alternative to microsurgical resection.

Third ventricular colloid cyst and organic hypomania

A colloid cyst is a cyst containing gelatinous material in the brain. Some colloid cysts result in acute onset of hydrocephalus and may lead to sudden death, and colloid cysts of the third ventricle frequently cause psychiatric disturbances leading to erroneous diagnosis of schizophrenia and neurosis. Here, Drs Javed and Dutta describe a case of third ventricle colloid cyst presenting with a seemingly functional psychiatric illness, which was treated neurosurgically and showed complete resolution of symptoms.

Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts

Colloid cysts are histologically benign lesions whose primary goal of treatment should be complete resection to avoid recurrence and sudden death. Open surgery is traditionally considered the standard approach, but, recently, the endoscopic technique has been recognized as a viable and safe alternative to microsurgery. The endoscopic approach to colloid cysts of the third ventricle is usually performed through the foramen of Monro. However, this route does not provide adequate visualization of the cyst attachment on the tela choroidea. The combined endoscopic transforaminal-transchoroidal approach (ETTA), providing exposure of the entire cyst and a better visualization of the tela choroidea, could increase the chances of achieving a complete cyst resection. Between April 2005 and February 2011, 19 patients with symptomatic colloid cyst of the third ventricle underwent an endoscopic transfrontal-transforaminal approach. Five of these patients, harboring a cyst firmly adherent to the tela choroidea or attached to the middle/posterior roof of the third ventricle, required a combined ETTA. Postoperative MRI documented a gross-total resection in all 5 cases. There were no major complications and only 1 patient experienced a transient worsening of the memory deficit. To date, no cyst recurrence has been observed. An ETTA is a minimally invasive procedure that can allow for a safe and complete resection of third ventricle colloid cysts, even in cases in which the lesions are firmly attached to the tela choroidea or located in the middle/posterior roof of the third ventricle.

Endoscopic transchoroidal and transforaminal approaches for resection of third ventricular colloid cysts

To review our experience over 10 years in endoscopic resection of third ventricular colloid cysts, describing the details of the transventricular-transchoroidal approach used in selected patients. This series included 24 patients with colloid cysts of the third ventricle treated in our department between October 2001 and January 2013 using an endoscopic approach. Clinical presentation, preoperative radiological findings, endoscopic technique employed, and complications were assessed in all patients. The mean length of patient follow-up was 5.16 years. The most common symptom was headache (75%). The average size of the resected colloid cysts was 16.25 mm, the maximum diameter measured in cranial magnetic resonance imaging. Resection was transforaminal in 16 cases (66.7%), transchoroidal in 7 (29.17%), and transseptal in 1; macroscopically complete resection was achieved in 23 of 24 procedures (95.8%). Complications included three intraventricular hemorrhages, four memory deficits (two of them transient), one case of temporary potomania, two soft tissue infections, and one meningitis. There were no statistically significant differences between the route of resection and number of complications. The Glasgow Outcome Scale at 1 year after surgery was 5 in 82.6% of the patients. A transventricular endoscopic approach allows macroscopically complete resection of third ventricle colloid cysts in most cases. The option of opening the choroidal fissure (transventricular-transchoroidal approach) during the procedure can address third ventricle colloid cysts that do not emerge sufficiently through the foramen of Monro without increasing procedure-related morbidity.

Sudden death in a patient with a third ventricle colloid cyst

Neurosurgical Department, Democritus University of Thrace Medical School, Alexandroupolis, Greece.Correspondence: Danilo Silva; Weill Cornell Medical College, New York NY, USA; Department of Neurological Surgery; Skull base fellow; 124 west 60th street Apt 37L; New York NY - USA; E-mail: daniloncr@gmail.comConflict of interest: There is no conflict of interest to declare.Received 21 October 2011; Received in final form 09 November 2011; Accepted 16 November 2011

Inheritance of nasal dermoid sinus cyst and evidence for association with third ventricle colloid cyst

The purpose of this paper is to study the possible inheritance of nasal dermoid sinus cyst in the Finnish population. A patient questionnaire and interview were utilized for this study. We identified nine patients with dermoid sinus cyst. Only one of them had familial nasal dermoid sinus cyst. We found no evidence for founder effect. We report a pedigree with six affected individuals and an association of nasal dermoid sinus cyst and third ventricle colloid cyst. Whether patients or pedigrees with nasal dermoid sinus cyst (NDSC) and third ventricle colloid cysts represent a previously unrecognized syndrome or belong to the normal phenotypic spectrum of NDSC remains unclear. Our patient material suggests that only minority of NDSCs seem to be familial.

Hemorrhagic Colloid Cyst with Sudden Coma

Third ventricle colloid cysts are regarded as benign lesions. They may, however, present with dramatic and rapidly deteriorating neurological signs, leading to sudden death. Although the exact cause of this clinical course is unknown, acute hydrocephalus caused by occlusion of Monro's foramina has been suggested. This, in turn, may be the result of acute cyst swelling, which can exceptionally be due to an intralesional hemorrhage. This report illustrates the case of a young patient who deteriorated to sudden coma and was found to have a hemorrhagic colloid cyst of the third ventricle. This was removed via a purely endoscopic technique. Although the radiological results were excellent, the clinical outcome was poor. This case suggests once again the importance of the early recognition of colloid cysts of the third ventricle for appropriate treatment before potentially irreversible neurological deterioration sets in.

Treatment of colloid cysts of the third ventricle through neuroendoscopic Nd: YAG laser stereotaxis

Colloid cysts (IIIVT CC) are benign neuroepithelial cysts located in the anterior third ventricle. The authors propose the use of Nd:YAG laser stereotactic neuroendoscopic for guided resection of the third ventricle colloid cysts. Eleven patients presented third ventricle colloid cysts and were treated by Nd:YAG laser guided with stereotactic endoscopy (n=7) , stereotactic endoscopy (n=3) or stereotactly guided puncture (n=1). The patients were followed prospectively (average 33 months, range 19-64 months). The clinical data, neuroimaging findings, hospitalization stay, outcomes and complications of the method were evaluated. All patients presented headache; six had papilledema, one had gait disturbance and one had third-nerve palsy. Neuroimaging showed hydrocephalus and a IIIVT CC with 14.4-mm mean diameter. After surgery all patients presented clinical and image improvement. Only two patients presented transient morbidities that were easily treated: One had diabetes insipidus that lasted for two days and was treated with a single dose of DDAVP, and another had chemical aseptic meningitis, probably due to the contact of the cyst content with the CSF. This patient was treated with antibiotics and corticosteroids with complete resolution of the problem without sequels. The other patients were discharged from the hospital 48 h after surgery. The stereotactic neuroendoscopy-guided procedure with Nd:YAG laser allowed the complete removal of the third ventricle colloid cysts, without definitive morbidities, sequels or recurrence of the lesion.

Intraventricular Textiloma with Granuloma Formation Following Third Ventricle Colloid Cyst Resection – A Case Report

Despite precautions, cotton and gauze pads used for dissection or to achieve haemostasis during neurosurgical procedures can inadvertently be left behind and result in clinically symptomatic or asymptomatic and radiologically apparent mass lesion, sometimes referred to as "textilomas" or "gossypibomas", often mimicking recurrent tumour or abscess on neuroimaging studies. We report the neuroimaging evaluation, including computed tomography (CT), magnetic resonance imaging (MRI) and spectroscopy (H1-MRS), in a case of textiloma developing after the treatment of a third ventricle colloid cyst.

DIZYGOTIC TWINS WITH A COLLOID CYST OF THE THIRD VENTRICLE

Colloid cysts of the third ventricle are rare benign tumors of endodermal origin accounting for 1% of all intracranial tumors. Interestingly, a few familial cases have been reported previously. We present the first case of dizygotic twins with a symptomatic colloid cyst of the third ventricle. A 10-year-old boy was admitted to a local hospital in 1993 because of severe progressive headache. Computed tomographic and magnetic resonance imaging scans revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst, which was removed after emergent ventricular drainage. Fourteen years later, a nonidentical twin brother complained of continuous headache with nausea and vomiting. A magnetic resonance imaging scan showed obstructive hydrocephalus and a third ventricle colloid cyst, which was removed by use of the transcallosal approach. Both twins underwent complete removal of the cyst by the interhemispheric transcallosal approach without postoperative complications. On the basis of a literature review, 2 cases of colloid cysts of the third ventricle in monozygotic twins and a few familial cases have been reported. Our case is the first in dizygotic twin brothers. These findings suggest that the prevalence of colloid cyst may be higher in twins than in the general population. We believe that the presence of this lesion in a twin necessitates magnetic resonance imaging of the other twin, and a clinical follow-up would be recommended in all other first-degree relatives.

Endoscopic Versus Microsurgical Resection of Third Ventricle Colloid Cysts

Endoscopic resection of colloid cysts has been performed as an alternative to microsurgical resection and stereotactic aspiration since 1982. To date, there are limited published studies comparing these procedures. In this study, we present the largest series of endoscopic resections published to date and compare outcomes to a cohort of microsurgical resections performed at the same institution. A retrospective chart review was conducted for all patients in the Calgary Health Region undergoing resection of a colloid cyst between 1991 and 2004. Comparison was made between patients treated with endoscopic resection versus microsurgical resection. Twenty-five endoscopic and nine microsurgical procedures were performed. Complete resection was achieved in 24 of 25 procedures in the Endoscopic group, compared with all 9 procedures in the Microsurgical group. Patients in the Endoscopic group had a reduced operative time (mean 104 minutes versus 217 minutes) and reduced length of stay (3.8 days versus 8.4 days) compared to the Microsurgical group. One patient in the Endoscopic group had a complication (hemiparesis/pulmonary embolus). By contrast, 3 patients in the Microsurgical group had complications (seizure, ventriculitis/bone flap infection, and transient memory deficit). There was one recurrence in each group which both occurred at 5 years follow-up. The mean length of follow-up is 38 months in the Endoscopic group and 33 months in the Microsurgical group. Endoscopic resection of colloid cysts can be performed with significantly lower risk of complication than microsurgical resection and with equivalent surgical success. Operative time and length of hospital stay are both significantly reduced with endoscopic resection.

Thunderclap headache: An approach to a neurologic emergency

Thunderclap headache (TCH) refers to an excruciating headache of instantaneous onset. Recognition and accurate diagnosis of this headache are important because it can be caused by various serious underlying brain disorders such as subarachnoid hemorrhage, intracranial hematoma, cerebral venous sinus thrombosis, cervical artery dissection, ischemic stroke, pituitary apoplexy, acute arterial hypertension, spontaneous intracranial hypotension, third ventricle colloid cyst, and intracranial infections. Patients with TCH who have evidence of reversible, segmental, cerebral vasoconstriction of circle of Willis arteries and normal or near-normal cerebrospinal fluid evaluation are considered to have reversible cerebral vasoconstriction syndrome. Primary TCH is diagnosed when no underlying etiology is identified. In this review, we discuss the differential diagnosis of TCH, outline the characteristics and diagnostic criteria for primary TCH, offer a pathophysiologic hypothesis for primary TCH, and detail the diagnostic evaluation of the patient presenting with TCH.

Colloid cysts of the third ventricle in children

The authors analyzed the surgical treatment results in 3 children with third ventricle colloid cysts. The patients were operated in the Institute of neurosurgery from 1994 to 2004. Clinical signs, CT and MRI diagnostic criteria were discussed. The transcortical-transventricular approach for the cyst ablation was used. No complications after the surgery were observed. The transcortical-transventricular approach is effective and safe for colloid cysts of the third ventricle ablating.

Intraventricular colloid cyst, hydrocephalus and neurogenic stunned myocardium

Objective: To report the occurrence of neurogenic stunned myocardium in the context of a hydrocephalus due to a third ventricle colloid cyst. Design: Case report. Setting: Neurocritical care unit of a university hospital. Patient: The case of a 33-year-old woman with an intraventricular cerebral colloid cyst who developed hydrocephalus, cardiac arrest and survived is presented. Workup was consistent with neurogenic stunned myocardium in the context of acute hydrocephalus due to an intraventricular colloid cyst. Results: The patient had decreased left ventricular ejection fraction, apex-sparing areas of hypokinesis and akinesis, wall motion abnormalities not matching a particular vascular territories, the peak troponin T level of 0.09 ng/ml and had normal coronary arteries at angiography. Seven days after the initial event the cardiac function recovered. Tumor resection was successfully performed. At 10 months after discharge, the only complaint was mild memory disturbance, she was completely functional with no evidence of seizures or of cardiac dysfunction. Conclusion: The sudden elevation of intracranial pressure, with the subsequent decreased cerebral perfusion pressure induces a vigorous cerebro-protective neuroendocrine system activation that can lead to the neurogenic stunned myocardium. Sudden death in patients with colloid cysts may be related to acute neurogenic cardiac dysfunction, and not necessarily cerebral herniation(s), as previously thought.

Transcortical-transventricular approach in colloid cysts of the third ventricle: surgical experience with 26 cases.

Colloid cysts of the third ventricle account for 0.5-2% of all intracranial tumors. The treatment of these benign tumors remains controversial, and the best surgical option has not yet been determined. Between 1995 and 2002, 27 patients with colloid cysts of the third ventricle presented at our clinic. Twenty-six underwent transcortical-transventricular approaches. One refused surgical treatment. There was no surgical mortality. The main morbidity was epileptic seizures in two patients. Overall outcome was good in all patients. The mean follow-up period was 3.4 years. There were no tumor recurrences. The transcortical-transventricular approach can be used safely to excise third ventricle colloid cysts with low risk of mortality and morbidity.

Commentary

Colloid cysts are uncommon benign lesions. There is a lack of consensus regarding the preferred surgical strategy for colloid cyst resection; the technique with the optimal rates of remission, recurrence, mortality, and complications is debatable.To determine surgical outcomes, we performed a systematic review of the published literature on Colloid cysts. Eligible studies (n = 63) with a prospective or retrospective evaluation of endoscopic or microscopic resection of third ventricle colloid cysts were included, which contained data describing extents of resection, seizures, meningitis, and tumor recurrence. A total of 3143 patients (1741 microscopically and 1402 endoscopically operated) were included in the final analysis.According to the results of the meta-analysis, there was a higher rate of gross total resection (GTR) (98.15% versus 91.29%, p = 0.00), need for shunting (4.75% versus 1.46%, p = 0.04), postoperative complications (20.68% versus 10.42%, P = 0.03), mean operating time (194.18 versus 113.04 min), and duration of hospitalization (7.85 versus 4.69 days) for microscopic resection compared with endoscopic resection. While endoscopic resection is associated with a higher rate of cyst recurrence (1.78% versus 0.00%, P = 0.00), there was no difference in reoperation rate (0.49% for endoscopic versus 0.09% for microscopic resection).Microsurgical resection of third ventricle colloid cysts was associated with a higher rate of GTR and a lower rate of recurrence, while there was a lower rate of postoperative complications, duration of surgery, and shorter hospitalization period in the endoscopic group.