Endoscopic Versus Microsurgical Resection of Third Ventricle Colloid Cysts

Abstract

Colloid cysts of the third ventricle represent about 0.5-2 percent of intracranial tumors.1,2 Although uncommon, they are an important clinical entity because of their ability to cause cerebrospinal fluid (CSF) obstruction and sudden death. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In one population-based study, one third of patients with symptomatic colloid cysts presented with acute neurological deterioration, underscoring the need for their treatment. There has been some debate over the optimal management of colloid cysts over the past few decades. Management options include CSF diversion procedures (e.g. ventriculo-peritoneal ABSTRACT: Objective: 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. Methods: 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. Results: 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. Conclusion: 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. RÉSUMÉ: Résection endoscopique versus microchirurgicale des kystes colloïdes du troisième ventricule.Objectif : La résection endoscopique des kystes colloïdes comme alternative à la résection microchirurgicale et à l'aspiration stéréotaxique est réalisée depuis 1982. À ce jour, peu d'études comparant ces interventions ont été publiées. Dans cette étude, nous présentons la plus grande série de résections endoscopiques publiée à ce jour et nous comparons les résultats à ceux d'une cohorte de patients ayant subi une résection microchirurgicale dans la même institution. Méthodes : Nous avons procédé à une ré...

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

“…1,11 Open surgery is traditionally considered the gold standard for the treatment of third ventricle colloid cysts, with many authors having reported a residual/recurrence rate ranging from 0% to 1.1% when using a transcallosal or transfrontal-transventricular approach. 5,6,8,10,13,18,19,26 How ever, these approaches have high operative morbidity and mortality rates because they are potentially associated with disabling complications such as venous infarction, hemiparesis, memory deficit, subdural hematoma, meningitis, and ventriculitis. 5,6,13,19,26 Taking these results into consideration, alternative options for the treatment of these lesions were investigated.…”

Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

“…108 Although uncommon, they are an important clinical entity because of their ability to cause CSF obstruction at the foramina of Munro with resultant hydrocephalus, which in the acute state can lead to sudden death. 108 If the obstruction of the foramina of Monro is asymmetrical, one lateral ventricle can grow larger than the other, resulting in bowing of the septum pellucidum to the nonaffected side. 109 Although microsurgery has been the classic treatment option, 110 the composition and location of these cysts make them ideally suited for endoscopic excision.…”

“…We have previously presented our data in comparison to microsurgical resections, showing that endoscopic resection of colloid cysts can be performed with a significantly lower risk of complications than microsurgical resection (4% vs 33%), and with equivalent surgical success. 108 In addition, operative time and length of hospital stay are both significantly reduced with endoscopic resection. Similar results were found in a series of 30 patients reported by Lewis et al, 116 where half underwent open resection and the other half endoscopic resection of a colloid cyst.…”

Endoscopy in Intracranial Pathology

“…Colloid cyst endoscopic surgery is described widely in the literature and is becoming a popular surgical technique in the management of these lesions (Grondin et al, 2007;Horn et al, 2007;. Navigation assisted endoscopy may be needed in some of these patients, especially when there is no accompanying hydrocephalus (Souweidane 2005).…”