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

Abstract

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.

Transcortical removal of third ventricular colloid cysts: a comparison of conventional, guided microsurgical and endoscopic approaches and a review of the literature

“…The high rate of incomplete removal for endoscopic CC surgery is attributed to the anatomical location of the cyst, which is tucked up underneath the roof of the third ventricle and difficult to reach through a burrhole located near the coronal suture with a rigid endoscope. Studies on the use of novel approaches to overcome this anatomical difficulty, or with dual endoscopic instruments report higher rates of total removal compared to standard endoscopic methods (7,22,46).…”

“…Cortical incision and parenchymal dissection were minimized by the use of stereotactically guided cylindrical retractor (4,6,25). Cortical injury was further reduced by the introduction of the neuroendoscope (14,18,21,22,28,30,46).…”

Peculiarities of the third ventricle surgery in endoscopic frontal transcortical approach

“…The damage to the anterior part of the floor of the third ventricle may cause water-salt metabolism disorder symptoms. Lateral to the foramen of Monro there is thalamus and the internal capsule, the injury to which may lead to coma or hemiplegia [10].…”

Bifrontal dual‐endoscopic resection of third ventricular colloid cyst

“…Compared with the dual‐port technique from the unilateral ventricle, this approach provides a wider angle between the two instruments for bimanual approach, and utilizes both foramina of Monro for access to the target lesion . Although this approach provides good access to the anterior third ventricle, dissection to more posteriorly located cyst attachment is limited, and might be better served with a transchoroidal approach, either endoscopically or via craniotomy …”