Treatment of colloid cysts of the third ventricle through neuroendoscopic Nd: YAG laser stereotaxis

Abstract

-Objective: Colloid cysts (IIIVT CC) are benign neuroepithelial cysts located in the anterior third ventricle. The authors propose the use of Nd:YAG laser stereotactic neuroendoscopic for guided resection of the third ventricle colloid cysts. Method: Eleven patients presented third ventricle colloid cysts and were treated by Nd:YAG laser guided with stereotactic endoscopy (n=7) , stereotactic endoscopy (n=3) or stereotactly guided puncture (n=1). The patients were followed prospectively (average 33 months, range 19-64 months). The clinical data, neuroimaging findings, hospitalization stay, outcomes and complications of the method were evaluated. Results: All patients presented headache; six had papilledema, one had gait disturbance and one had third-nerve palsy. Neuroimaging showed hydrocephalus and a IIIVT CC with 14.4-mm mean diameter. After surgery all patients presented clinical and image improvement. Only two patients presented transient morbidities that were easily treated: One had diabetes insipidus that lasted for two days and was treated with a single dose of DDAVP, and another had chemical aseptic meningitis, probably due to the contact of the cyst content with the CSF. This patient was treated with antibiotics and corticosteroids with complete resolution of the problem without sequels. The other patients were discharged from the hospital 48 h after surgery. Conclusion: The stereotactic neuroendoscopy-guided procedure with Nd:YAG laser allowed the complete removal of the third ventricle colloid cysts, without definitive morbidities, sequels or recurrence of the lesion.KEY WORDS: laser, neuroendoscopy, third ventricle, colloid cysts.Tratamento do cisto colóide do terceiro ventrículo por neuroendoscopia estereotática com laser Nd:YAG Resumo -Objetivo: Os cistos colóides (CC IIIVT) são lesões neuroepiteliais benignas localizadas anteriormente no terceiro ventrículo. Nós propomos a ressecção neuroendoscópica com o uso do Nd:YAG laser guiada por estereotaxia. Método: Onze pacientes portadores de cisto colóide do terceiro ventrículo foram tratados por neuroendoscopia estereotática com laser Nd:YAG (n=7), neuroendoscopia estereotática (n=3) ou punção estereotática (n=1) e foram seguidos prospectivamente (média 33 meses, variação 19-64 meses). Os dados clínicos, achados de neuroimagem, tempo de hospitalização, evolução e complicações referentes à técnica foram avaliadas. Resultados: Todos pacientes apresentaram cefaléia; seis tiveram papiledema, um apresentou distúrbio de marcha e um apresentou paresia do terceiro nervo. Os exames de neuroimagem evidenciaram hidrocefalia e CC IIIVT com diâmetro médio de 14,4 mm. Depois da cirurgia todos os pacientes apresentaram melhora clínica e de imagem. Apenas dois pacientes apresentaram morbidades transitórias que foram facilmente tratadas: um apresentou diabetes insipidus que durou dois dias e foi tratada com uma única dose de DDAVP, o outro apresentou meningite química asséptica, provavelmente pelo contato do conteúdo do cisto com o líquor. Este paciente recebe...

Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention

“…All these complications are severe, require reoperation, and may cause death 2,3,[7][8][9][10][11][12][13] . Currently, there is a consensus that, whenever possible and indicated, one should avoid VS implantation when a high complication rate is identified in the long-term (mean of 60 months) of up to 51% of cases; in these cases, ventricular neuroendoscopic procedures are given preference 12,[14][15][16][17] . To prevent infectious complications, the institutional adoption of protocols, such as first described by Choux, is what shows the most positive impact and control of these complications.…”

Management of colloid cyst of third ventricle

“…A transparent retractor provides a safer and effective alternative that is not limited by the vascularity, friability, or size of the lesions (15). A Nd:YAG laser can be used for total removal of third ventricle colloid cysts without any increase in morbidity (44).…”

Application of a 980-nanometer diode laser in neuroendoscopy: a case series

“…They were treated and discharged from the hospital without sequelae. 10 It is difficult to compare these results with our present study because we used a 980-nm diode laser to treat ventricular pathologies other than colloid cysts. However, we did not find any difference relative to their intraoperative use and had good results using both devices.…”

“…4,5,6,7,12,15,17 Nonetheless, because a ventricular endoscope is used through a single bur hole, additional resources to enable cutting, coagulation, and ablation of injuries are extremely relevant to reduce surgical time and hospital length of stay, and increase the safety of the procedure and the patient's postoperative comfort. 8,10,18 Increasing experience in several centers has proven that laser-assisted endoscopic procedures are useful options, because they are safe, effective, and advantageous in cases of distorted anatomy. 4,18 We have previously shown favorable results of surgical Nd:YAG and therapeutic laser (diode 685 nm) in neuroendoscopic procedures, such as excision of colloid cysts and myelomeningocele repair.…”

“…4,18 We have previously shown favorable results of surgical Nd:YAG and therapeutic laser (diode 685 nm) in neuroendoscopic procedures, such as excision of colloid cysts and myelomeningocele repair. 10,11 Furthermore, the use of 980-nm diode laser in brain tissue of Wistar rats has been tested in recent studies and was associated with a remarkable ablating capacity, minimal thermal damage to surrounding tissue, and lower recovery time than other lasers with different wavelengths or electrocoagulators. The 980-nm-wavelength diode laser provides proper absorption in both water and hemoglobin, which is an adabbreviatioNs μ A (H 2 O) = absorption coefficient of water; CW = continuous wave; ETV = endoscopic third ventriculostomy.…”