Management of colloid cyst of third ventricle

Abstract

Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic for long time while some can present with paroxysmal headache, gait disturbance, nausea, vomiting, behavioral changes, weaknesses of lower limbs, impaired memory, new learning disability and sudden death. Computed tomography usually reveals a well-defined round or oval nonenhancing lesion. Although magnetic resonance imaging (MRI) signal intensity of colloid cysts is variable, the most common appearance is hyperintensity in T1-weighted sequences and iso to hypointensity in T2-weighted sequences. Observation, stereotactic aspiration, microscopic or endoscopic approaches and shunt surgery are various management options. Transcallosal and transcortical microscopic (with or without tubular retractor) approaches are mainly useful in normal-sized and dilated ventricles respectively. Endoscopic technique is an effective alternative to microsurgical technique but total resection and long-term recurrence remains a concern. Utilization of two instruments, the bi port technique and tubular retractor can be helpful in selected patients to overcome limitations. Although total excision should be aimed, subtotal excision and coagulation of residual cyst wall usually results in good long-term results without any growth of remnant wall. Conversion to an open procedure may be required in some patients.KEywords: Central nervous system cyst, Central nervous system neoplasm, Colloid cyst, Nervous system diseases, Third ventricle ÖZKolloid kistler genellikle üçüncü ventrikülde bulunur ve primitif nöroepitel veya endodermden köken aldıklarına inanılmaktadır. Hastalar uzun süre belirtisiz kalabilirler veya durum paroksismal baş ağrısı, yürüme bozukluğu, bulantı, kusma, davranış değişiklikleri, alt ekstremitelerde kuvvetsizlik, hafıza kaybı, yeni şeyler öğrenme zorluğu ve ani ölümle ortaya çıkabilir. Bilgisayarlı tomografi genellikle iyi tanımlanmış yuvarlak veya oval, kontrast tutmayan bir lezyon gösterir. Kolloid kistlerin manyetik rezonans görüntüleme (MRG) sinyal şiddeti değişkendir ama en sık rastlanan görünüm T1 ağırlıklı dizilerde hiperintens ve T2 ağırlıklı dizilerde izo ila hipointenstir. Gözlem, stereotaktik aspirasyon, mikroskopik veya endoskopik yaklaşımlar ve şant cerrahisi çeşitli tedavi seçenekleridir. Transkallosal ve transkortikal mikroskopik (tübüler retraktörle veya olmadan) yaklaşımlar temel olarak sırasıyla normal büyüklükte ve dilate ventriküllerde faydalıdır. Endoskopik teknik, mikrocerrahi tekniğe etkin bir alternatiftir ama total rezeksiyon imkanı ve uzun dönemde nüks olasılığı endişe yaratmaya devam etmektedir. İki alet kullanımı, iki portlu teknik ve tübüler retraktör bazı hastalarda sınırlamaları aşmak açısından faydalı olabilir. Total eksizyon hedeflenmelidir ama subtotal eksizyon ve kalan kist duvarının eksizyonu genellikle kalan duvarda bir büyüme olmadan uzun dönemli iyi sonuçlar verir. Bazı hastalarda açık cerrahiye dönmek de gerek...

Comparative evaluation of microscopic vascular decompression and endoscopic vascular decompression for trigeminal neuralgia: A clinical study

“…It is also useful for various types of pathologies such as congenital lesions, hematomas evacuation, tumor excisions, and infective pathologies. [11][12][13] Endoscopic techniques for TN were found to be safe in our study; other authors made similar observations. The endoscopic procedure was very effective with good outcome rate in our study, as other authors have also observed.…”

Utility of Tubular Retractors Augmented with Intraoperative Ultrasound in the Resection of Deep-seated Brain Lesions: Technical Note

“…Tubular retractors have been used in the treatment of intracerebral hemorrhage and vascular lesions. Several studies have demonstrated the efficacy of this technique in the evacuation of deep brain hematomas, access ruptured periventricular aneurysms and cerebral cavernous malformations, and resection of deep-seated brain tumors with minimally invasive trans-sulcal parafascicular resection [8-15].…”

Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome

“…Despite colloid cyst of the anterior third ventricle being a different cystic tumor in a slightly distinct anatomical location compared with EC, due to its more common incidence,[ 67 ] two studies have compared open microsurgical versus endoscopic surgical techniques. Grondin et al .…”