Ventricular Colloid Cysts Research Articles

SURG-20. DEVELOPING ENDOSCOPIC RESECTION OF COLLOID CYSTS: A 25-YEAR EXPERIENCE IN 200 PATIENTS

Abstract Endoscopic resection is a legitimate treatment alternative for third ventricular colloid cysts. Increasing experience and the development of new surgical instruments and techniques have allowed this approach to reach clinical prominence. In this study, we review our 25-year experience with endoscopic resection of colloid cysts, assess factors predictive of operative success, and critically analyze our evolving clinical practice. Therefore, a prospective database was used to review all patients that had endoscopic removal of a third ventricular colloid cyst between 1995 and 2021. Demographics, imaging features, presenting symptomatology, operative approach, surgical outcomes, and complications were analyzed in 5-year intervals to determine changing patterns over time. Bivariate analyses were carried out to understand factors predisposing to outcome. Kaplan-Mayer curves were used to analyze time-to-recurrence. Over this 25-year continuum an increase in the proportion of treated patients who were asymptomatic (p < 0.001) was observed. The rate of recurrence and length of stay all decreased over time (p < 0.001) – now, with median length of stay of 1 day. The rate of complete cyst removal (CCR) increased (p < 0.001). Rate of major complications or need for postoperative CSF diversion remained low. Bivariate analyses indicated how incomplete cyst removal (ICR) was associated with recurrence. In conclusion, our 25-year experience posits endoscopic resection as an increasingly safe approach to third ventricular colloid cysts, with low recurrence rates and negligible complications. These results are attributed in-part to a continuous adaptation related to instrumentation, technique, perioperative strategy, and experience.

Hemorrhagic Fourth Ventricle Colloid Cyst: A Report of an Unusual Presentation at an Uncommon Location

AbstractColloid cysts are benign cystic lesions characteristically arising from the third ventricle roof close to the foramen of Monro. Although incredibly rare, hemorrhage within a third ventricular colloid cyst is sparsely reported. To the best of our knowledge, no cases of hemorrhage within the fourth ventricle colloid have ever been documented. Here, we present an interesting case describing a hemorrhagic colloid cyst situated within the fourth ventricle of a 55-year-old female patient who presented with symptoms of headache, vomiting, and gait imbalance. The cyst was excised during surgery via a suboccipital microscopic telovelar approach. Our findings led us to the conclusion that, despite being extremely rare, colloid cysts in the fourth ventricle can present with hemorrhagic episodes, which can exacerbate symptoms and hasten neurological decline. As a result, the presence of unusual radiological characteristics in a fourth ventricle lesion should prompt medical practitioners to suspect an atypical colloid cyst. This consideration can be pivotal in making informed surgical decisions. Expedited management and a microsurgical approach are recommended strategies for a better outcome.

Third Ventricular Colloid Cyst, New Surgical Classification

This research discusses colloid cyst surgical concerns, with an emphasis on the value of a novel surgical classification based on anatomical sites. In the study, 59 patients who underwent surgical intervention between 2009 and 2022 and were diagnosed with colloid cysts via CT scan and MRI participated.There were more male cases than female ones (57.6%). The majority of patients presented with headache (79%), followed by abnormal gait (12%), visual blurring (5%) and seizures (4%).In this study, we present a new surgical classification based on anatomical locations, distinguishing four types: open Monro type (50.84%), closed Monro type (23.72%), retro-foraminal type (13.55%), and interforniceal type (11.86%).In summary, the surgical classification that has been suggested provides significant insights into the varied anatomical sites where colloid cysts might be found. Microneurosurgeons significantly need to be oriented about the possible sites of colloid cysts through this classification to achieve complete and curative resection and reduce the likelihood of recurrence.

Endoscopic Removal of Third Ventricular Colloid Cyst, A Single Institution, 6-Year Experience

Endoscopic Removal of Third Ventricular Colloid Cyst, A Single Institution, 6-Year Experience

Gamma Knife Radiosurgery for Third Ventricular Colloid Cysts: A Retrospective Study

Introduction: Colloid cysts often occur in the third ventricle, and they are considered benign, slowly growing lesions. They commonly present with symptoms of intracranial hypertension and rarely sudden death due to acute hydrocephalus. The management options include cerebrospinal fluid diversion procedure by shunt, endoscopic or transcranial surgical excision, and stereotactic aspiration. Complications associated with excisional procedures make them undesirable to some patients. Stereotactic radiosurgery has emerged as a noninvasive less risky treatment option. To date, there is no clinical series in the literature reporting on this treatment modality. The aim of the study was to determine the efficacy and safety of gamma knife (GK) radiosurgery in the treatment of third ventricular colloid cysts. Methods: This is a retrospective study involving 13 patients with third ventricular colloid cysts who underwent GK radiosurgery. GK radiosurgery was used as a primary treatment in all the patients. The median prescription dose was 12 Gy (11–12 Gy). The cyst volumes ranged from 0.2 to 10 cc (median 1.6 cc). Results: The median follow-up was 50 months (18–108 months). Cyst control was achieved in 100% of the patients. Complete or partial response was observed in 12 patients (92%). Eight patients (62%) had hydrocephalus on imaging at the initial diagnosis. Seven of these patients had VP shunt insertion before GK. One patient required shunt insertion after GK. Conclusion: GK for third ventricular colloid cysts is a promising treatment, regarding its efficacy and safety, to be added to other treatment options. A longer follow-up is required to confirm long-term control.

Full-endoscopic removal of third ventricular colloid cysts: technique, results, and limitations.

Colloid cysts (CCs) are rare benign lesions that usually arise from the roof of the third ventricle. They may present with obstructive hydrocephalus and cause sudden death. Treatment options include ventriculoperitoneal shunting, cyst aspiration, and cyst resection microscopically or endoscopically. This study aims to report and discuss the full-endoscopic technique for removing colloid cysts. A 25°-angled neuroendoscope with an internal working channel diameter of 3.1 mm and a length of 122 mm is used. The authors described the technique of resecting a colloid cyst by a full-endoscopic procedure and evaluated the surgical, clinical, and radiological results. Twenty-one consecutive patients underwent an operation with a transfrontal full-endoscopic approach. The swiveling technique (grasping the cyst wall and rotational movements) was used for CC resection. Of these patients, 11 were female, and ten were male (mean age, 41 years). The most frequent initial symptom was a headache. The mean cyst diameter was 13.9 mm. Thirteen patients had hydrocephalus at admission, and one needed shunting after cyst resection. Seventeen patients (81%) underwent total resection; 3 (14%), subtotal resection; and 1 (5%), partial resection. There was no mortality; one patient had permanent hemiplegia, and one had meningitis. The mean follow-up period was 14 months. Even though microscopic resection of cysts has been widely used as a gold standard, successful endoscopic removal has been described recently with lower complication rates. Applying angled endoscopy with different techniques is essential for total resection. Our study is the first case series to show the outcomes of the swiveling technique with low recurrence and complication rates.

Acute hydrocephalus caused by a colloid cyst — a case report

BackgroundColloid cysts are rare benign, slowly growing intracranial tumors of endodermal origin. Most colloid cysts are found incidentally and are asymptomatic, but rarely, they can lead to sudden death.Case presentationA 73-year-old female patient was admitted to our emergency department with complaints of dizziness, nausea, vomiting, fatigue, walking difficulties, and behavioral changes. CT imaging revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst. The patient was immediately transferred to a tertiary center where she underwent successful neurosurgical resection of the mass. Pathology results of the lesion confirmed the diagnosis of colloid cyst.ConclusionThe case we present emphasizes the critical importance of prompt identification of warning signs, complex thinking, and evaluation. Establishing the right diagnostic approach early on can facilitate accurate diagnosis.

Postoperative cerebro spinal fluid diversion in patients with third ventricular colloid cysts

Colloid cysts are a group of CNS neoplasms that usually present with features of CSF flow obstruction. The treatment is by microsurgical, endoscopic or stereotactic techniques. Hydrocephalus usually resolves postoperatively, but in around 3-7% of cases symptoms persist and ultimately require CSF diversion. Several factors such as operative approach, cyst size, operative time, intraoperative bleeding may influence the need for CSF diversion but most of these are yet to be statistically proven. Existing literature is mainly focused on incidence of CSF diversion after resection of colloid cyst rather than the factors which may predict its necessity and extensive research is required to accurately determine these factors.

Septostomy of septum pellucidum – Salvage technique for reversal of ventricular collapse during pure endoscopic surgical resection of third ventricular colloid cyst

Colloid cysts are benign cystic lesions. Frequently discovered incidentally, they can be severely debilitating and in rare occasions result in sudden death if not managed appropriately. The surgical options for removal include an open approach, as well as minimally invasive, endoscopic approach. Although associated with decreased morbidity, the endoscopic approach at times must be converted to an open procedure. Finding methods to reduce this conversion can help reduce the associated increase in morbidity.Here we present an endoscopic colloid cyst removal, during which collapse of the ventricle prevented visualization of the working area. A septostomy of the septum pellucidum was done to successfully re-expand the collapsed ventricle and return proper visualization to finish the surgery.Ventricular collapse in pure endoscopic approaches of colloid cyst removal prevents the surgeon from properly visualizing the working area and can frequently result in abortion of the procedure or conversion to open surgery. Because the pure endoscopic approach is associated with less morbidity, it is of benefit to have a salvage technique that prevents conversion to open surgery. Furthermore, fenestration of the septum pellucidum as a salvage technique may be a helpful salvage technique when dealing with ventricular collapse during other pure endoscopic procedures.

Outcome of Endoscopic Excision of the Third Ventricular Colloid Cyst

Outcome of Endoscopic Excision of the Third Ventricular Colloid Cyst

Perspectives on Endoscopic Transseptal Interforniceal Approach for Retroforaminal Colloid Cysts

Although the interforniceal approach with the preservation of the fornix is useful during the endoscopic approach for retroforaminal colloid cysts, it carries a significant risk of memory and cognitive difficulties. Because most reports have reported the endoscopic approach to colloid cysts through the foramen with little emphasis on retroforaminal cysts, the aim of this study was to investigate colloid cysts as a special entity with regard to their different characteristics and surgical approaches and outcomes. In this retrospective study, 12 patients with third ventricular colloid cysts with retroforaminal extensions were included. All patients underwent endoscopic transseptal interforniceal approach with tumor resection. The surgical technique was briefly described, and preoperative and postoperative data were evaluated. Among the 12 patients included in this study, most of our patients were males. Average diameter of the colloid cyst was relatively large (average 22 mm). Gross total resection was achieved in 10 cases (83.3%). The stable images showed no local recurrence in the long-term follow-up period except in 1 case at the 28-month follow-up period. Retroforaminal colloid cyst represents a unique entity that requires special attention to its mode of growth. The endoscopic approach for retroforaminal colloid cysts is nearly the same as that for foraminal cysts. It has a lower incidence rate of postoperative memory changes, lower chances of total resection, and lower incidence rate of hard contents. Moreover, sufficient knowledge on morbid anatomy is important to avoid fornix 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.

Transcortical Approach to Deep-Seated Intraventricular and Intra-axial Tumors Using a Tubular Retractor System: A Technical Note and Review of the Literature.

Retraction of white matter overlying a brain lesion can be difficult without causing significant trauma especially when using traditional methods of bladed retractors. These conventional retractors can produce regions of focal pressure resulting in contusions and areas of infarct. In this article, we present a retrospective case series of six patients with deep-seated intraventricular and intra-axial tumors that were approached using a ViewSite Brain Access System (tubular retractor). The authors describe a unique method of creating a pathway using a dilated glove. We shall also review the relevant literature that reports this type of surgery. Cases included three cases with third ventricular colloid cysts, one case of a third ventricular arachnoid cyst, one case with a lateral ventricular neurocytoma, and a case with a deeply seated intra-axial metastatic tumor. Gross total resection was achieved in five cases with small residual in the central neurocytoma operation, with no documented neurological deficit in any case. One case had persistent memory problems and one case had continuing decline from the metastatic disease. The introduction of tubular-shaped retractor systems has offered the advantage of reducing retraction pressures and distributing any remaining force in a more even and larger distributed area, thus reducing the risk of previous associated morbidity while also permitting great visualization of the target lesion.

Risk Analysis and Management of Third Ventricular Colloid Cysts

Colloid cysts (CCs) are histologically benign lesions that carry the risk of causing obstructive hydrocephalus. The indication for surgery for symptomatic cysts is unquestioned; however, the management of incidentally detected lesions has remained controversial. We independently evaluated the CC risk score (CCRS) as a useful risk stratification scheme. The demographics, imaging characteristics, and clinical presentations of 103 patients with CC during a 10-year period were correlated with symptoms and the occurrence of hydrocephalus. The discriminate capacity of the CCRS was quantified and a decision algorithm formulated. The correlates of symptoms included age <65 years, diameter ≥7 mm, anterior location, hyperintensity on T2-weighted fluid-attenuated inversion recovery (FLAIR) and/or T2-weighted images, and headache at presentation without an alternative explanation. On multivariate analysis, age <65 years, diameter ≥7 mm, and headache at presentation predicted for symptomatic cysts. The CCRS was highly effective at identifying symptomatic patients and those with obstructive hydrocephalus. All patients with cyst growth and symptomatic progression had had an initial CCRS of ≥3 plus hyperintensity (preexisting or developing) on T2-weighted FLAIR images. The CCRS performed exceptionally well in distinguishing the highest risk patients. Closer follow-up is recommended for younger asymptomatic patients withcysts near the foramen of Monro. Hyperintensity on T2-weighted FLAIR images might indicate greater growth potential for small lesions.

Endoscopic Removal of Third Ventricular Colloid Cyst: A Case Report

Third ventricular colloid cyst is slow-growing benign tumor comprising &lt;1% of intracranial tumors. Previously it was removed by interhemispheric transcallosal or transcortical approach. Now a days, endoscopic removal of colloid cyst is a popular option because it is less invasive, panoramic view helps in total removal of tumor. Here we are reporting a 8 years old boy presented with occasional headache, vomiting, seizure and loss of consciousness for 3 months. Neuro-imaging revealed anterior third ventricular colloid cyst. We removed the tumor completely with rigid neuroendoscope which was confirmed by histopathology. After three months follow up patient was quiet healthy.&#x0D; Bang. J Neurosurgery 2020; 10(1): 119-122

The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly.

While third ventricular colloid cysts may present as an incidental finding, they also harbor the potential to cause ventricular obstruction and sudden death. Herein we analyze the relationship between imaging appearance and the risk of obstructive ventriculomegaly. This is a retrospective review of the MR imaging appearance of 64 patients with colloid cysts, 46 of whom also had a CT scan, obtained by a tertiary hospital imaging report data base search over a 10-year period. Cysts were categorized by appearance on T2-FLAIR and correlated with patient age, cyst size, and the risk of obstructive ventriculomegaly. Histopathologic correlation was available for 28 cases. The 64-patient cohort was 52% female, median age 50 years (range 10 to 99 years). Cysts hyperintense on T2-FLAIR (53.1%) were larger (P <.001), occurred in younger patients (P = .01), and had a higher risk of obstructive ventriculomegaly than homogeneously hypointense cysts (relative risk 6.18, 95% CI [2.04, 18.67]). Three patterns of T2 hyperintensity were identified: homogeneously hyperintense, hyperintense rim, and cysts with "dot sign." Although "dot sign" cysts were larger (P < .001), there was no significant difference in patient age or the risk of ventricular obstruction among T2 hyperintense cysts. Cyst wall histopathology did not vary with imaging appearance. Hyperintensity on T2-FLAIR, whether homogeneous, rim, or "dot sign," is associated with larger cyst size and younger patient age, and is an imaging risk factor for obstructive ventriculomegaly. The hyperintense rim does not represent a thickened cyst wall.

In Reply: Colloid Cysts: Evolution of Surgical Approach Preference and Management of Recurrent Cysts.

BACKGROUND Optimal management of third ventricular colloid cysts remains debated. While microsurgery offers greater resection rates and lower recurrences, endoscopy offers a perceived less invasive option. OBJECTIVE To describe the evolution of our practice to favor microsurgery and determine the optimal management of recurrent colloid cysts. METHODS Any patient having undergone surgery for a colloid cyst by the senior author was identified and included in the study cohort. Clinical, radiographic, and operative records were reviewed, with attention paid to those patients requiring recurrent surgery. RESULTS Thirty-three patients were treated for intracranial colloid cysts between 1995 and 2017. Two patients had initial surgical treatment at an outside institution prior to presentation at our institution. Microsurgery was used in 15/31 initial cases, endoscopy in 13 cases, and ventriculoperitoneal shunting in 3 cases. Between 1995 and 2005, 89% of colloid cysts (8/9 cases) were resected endoscopically, whereas 74% of colloid cysts (14/19 cases) were resected by microsurgery after 2005. Of the 13 patients treated endoscopically, 6 (46%) required surgery for recurrent cysts. Incomplete cyst wall resection at the initial operation increased the recurrence rate to 55%. There were no recurrences in the microsurgery cohort. CONCLUSION Surgical resection of recurrent colloid cysts should focus on complete removal of the cyst wall to minimize the chance of recurrence. Microsurgery has been shown to provide the highest success rates for cyst wall resection and lowest rates of recurrence and is therefore recommended for patients undergoing surgery for primary and recurrent colloid cysts.

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).

Clinical Results and Complications in Patients Operated for Colloid Cyst

Aim: The present study aimed to report the peri- and postoperative complications in patients undergoing third ventricular colloid cyst resection using a microsurgical approach.Materials and Methods: A total of 29 patients with symptomatic third ventricular colloid cysts were operated upon via the microsurgery method at two different neurosurgery clinics, and their data were analyzed retrospectively.Results: Among them, 12 (41.4%) were men, and 17 (58.6%) were women. The mean age was 34.24 ±16.43 years, and the age range was 1–70 years. Headache was the most common symptom at reference and occurred in 21 (72.4%) patients. Also, ataxia was the presenting symptom in 7 (24.1%) of our patients, vomiting in 6 (20.7%), visual loss in 6 (20.7%), epileptic seizures in 4 (13.8%), incontinence in 4 (13.8%), and loss of consciousness in 1 (3.4%). Moreover, 19 (65.5%) had hydrocephalus, and two of them with weak consciousness were operated after the application of a preoperative external ventricular drainage systemConclusion: The interhemispheric transcallosal approach is the most commonly used method in colloid cyst microsurgery, and the most frequent surgical complication is venous infarction secondary to this approach. Thus, the significant results of infarct that occurred in patients with preoperative hydrocephalus suggest that this complication could be controlled more easily if the hydrocephalus and intracranial pressure are followed up more carefully in the pre- and perioperative periods.

Colloid Cysts: Evolution of Surgical Approach Preference and Management of Recurrent Cysts.

Optimal management of third ventricular colloid cysts remains debated. While microsurgery offers greater resection rates and lower recurrences, endoscopy offers a perceived less invasive option. To describe the evolution of our practice to favor microsurgery and determine the optimal management of recurrent colloid cysts. Any patient having undergone surgery for a colloid cyst by the senior author was identified and included in the study cohort. Clinical, radiographic, and operative records were reviewed, with attention paid to those patients requiring recurrent surgery. Thirty-three patients were treated for intracranial colloid cysts between 1995 and 2017. Two patients had initial surgical treatment at an outside institution prior to presentation at our institution. Microsurgery was used in 15/31 initial cases, endoscopy in 13 cases, and ventriculoperitoneal shunting in 3 cases. Between 1995 and 2005, 89% of colloid cysts (8/9 cases) were resected endoscopically, whereas 74% of colloid cysts (14/19 cases) were resected by microsurgery after 2005. Of the 13 patients treated endoscopically, 6 (46%) required surgery for recurrent cysts. Incomplete cyst wall resection at the initial operation increased the recurrence rate to 55%. There were no recurrences in the microsurgery cohort. Surgical resection of recurrent colloid cysts should focus on complete removal of the cyst wall to minimize the chance of recurrence. Microsurgery has been shown to provide the highest success rates for cyst wall resection and lowest rates of recurrence and is therefore recommended for patients undergoing surgery for primary and recurrent colloid cysts.