Endoscope-assisted removal of colloid cysts of the third ventricle

Abstract

Colloid cysts are benign space-occupying lesions, which arise from the velum interpositum or the choroid plexus of the third ventricle and are able to produce symptomatic obstruction of the foramina of Monro with resultant hydrocephalus. In our department, we have operated on colloid cysts routinely in an endoscope-assisted microsurgical manner via a key-hole approach. During a period of 10 years, 28 microsurgical resections of colloid cysts of the third ventricle were performed. Seven patients demonstrated colloid cysts inside the third ventricle with obstruction of the right foramen Monro, two patients demonstrated cysts with obstruction of the left foramen Monro. Twelve patients suffered from cysts inside the third ventricle with obstruction of both foramina Monro and five patients demonstrated cysts lying into the third ventricle without obstruction of the foramina. In 21 patients no preoperative therapy was performed outside. Three patients had received shunt systems before in other hospitals, two patients received aspiration of the cysts under stereotactic conditions and two patients received external ventricular drains. Total removal of the cyst was achieved in all patients (100%). No patient received a second operation, because none had a recurrent cyst. All cysts were removed with the cyst wall. Overall clinical improvement was achieved in a long-standing period between 6 and 83 months in 27 (96%) patients. In one patient (4%) the psychomotor disturbance was unchanged and no patient deteriorated. From the microsurgical point of view, the combination of keyhole surgery under endoscopic visual control using preexisting anatomical windows offers an effective minimally invasive approach.

Colloid cyst of the third ventricle: a clinical series of 19-cases

“…It is a minimal invasive method allowing a well visualization (27). In colloid cyst patients with a normal size ventricular system, endoscopic colloid cyst resection may result in vein and nerve injuries.…”

Ventricular endoscopy in the pediatric population: review of indications

“…In the case of endoscope-assisted microsurgical approaches, Charalampaki et al described colloid cyst resections in 28 patients with gross total resection and no recurrence. Postoperative complications included mild memory disturbances, psychomotor retardation, midbrain syndrome, and meningitis in limited cases [114]. A wide variety of surgical approaches exist in the treatment of cystic mass lesions, but many are technically difficult and fail to remove such masses in full without significant risk to surrounding structures dictating neurologic and endocrine function.…”

“…An endoscopicassisted endoport approach allows good microsurgical access combined with excellent lighting and visualization through the endoscope. The utility of such approaches has been noted in the resection of colloid cysts, arachnoidal cysts, primitive neuroectodermal tumors, Rathke cysts, hypothalamic hamartomas, and other intraventricular masses, and seems to represent a new approach to the management of complex ventricular lesions [100,114,[126][127][128].…”

Rate of Recurrence following Stereotactic Aspiration of Colloid Cysts of the Third Ventricle

“…Since the late 1980s, endoscopic procedures for colloid cysts have become popular [16] . However, most endoscopic procedures result in aspiration of the cyst's contents or partial excision of the cyst wall.…”