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Gurses ME, Lu VM, Gecici NN, Shah KH, Gökalp E, Bashti M, Haider S, Komotar RJ. Utilizing tubular retractors in colloid cyst resection: A single surgeon experience. Surg Neurol Int 2024; 15:179. [PMID: 38840593 PMCID: PMC11152534 DOI: 10.25259/sni_231_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
Background Colloid cysts are intracranial lesions originating from abnormalities in the primitive neuroepithelium folding of the third ventricle. Various surgical approaches have been explored for the management of colloid cysts, each carrying its own set of advantages and limitations. Tubular retractors developed recently alleviate retraction pressure through radial distribution, potentially offering benefits for colloid cyst resection. This study aims to introduce and assess a modified microsurgical method utilizing the tubular retractor for addressing colloid cysts. Methods The study included a retrospective assessment of patients who had colloid cysts and who were treated between 2015 and 2023 by one experienced surgeon. The demographic, clinical, radiological, histological, and surgical data regarding these patients were evaluated. The patients were assessed using the colloid cyst risk score, indicating a risk for obstructive hydrocephalus. Results The minimally invasive microsurgical approach was successfully applied to all 22 identified patients. No postoperative surgical complications were reported. Gross total resection was achieved in 21 (95.5%) patients. The early complication rate was 22.7% (n = 5). There were no postoperative seizures, permanent neurological deficits, or venous injuries. The average hospital stay was 3 days. There was no evidence of recurrence at an average follow-up length of 25.9 months. Conclusion The transtubular approach is an effective, safe method for treating colloid cysts. It achieves complete cyst removal with minimal complications, offering the benefits of less invasiveness, improved visualization, and reduced tissue disruption, strengthening its role in colloid cyst surgery.
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Affiliation(s)
| | - Victor M. Lu
- Department of Neurosurgery, Miami University, Miami, United States
| | | | | | - Elif Gökalp
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Malek Bashti
- Department of Neurosurgery, Miami University, Miami, United States
| | - Sameah Haider
- Department of Neurosurgery, Miami University, Miami, United States
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Carretta A, Zoli M, Martinoni M, Rustici A, Conti A, Mazzatenta D, Palandri G. Isolated entrapment of the lateral ventricle after neuroendoscopic resection of colloid cysts: single - center experience and management. Clin Neurol Neurosurg 2023; 232:107890. [PMID: 37480784 DOI: 10.1016/j.clineuro.2023.107890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND A minimally invasive option of colloid cyst surgical treatment is endoscopic resection, well validated in various reports and clinical practice. A rare complication of the surgical treatment, previously reported only once in literature, is the entrapment of the lateral ventricle. In this study we aim to outline our experience in the management of this occurrence, hypothesizing possible etiopathogenetic causes. METHODS Among patients who underwent neuroendoscopic resection for a colloid cysts at our Institution between 2013 and 2022, cases who developed a postoperative lateral ventricle entrapment were retrospectively reviewed and included. Clinical history, imaging and treatment were reported. RESULTS Among 34 patients treated for a colloid cysts, two (5.9 %) patients developed an ipsilateral ventricular entrapment with dilation from two to five months after the resection. Both patients were substantially asymptomatic and neurologically intact, and therefore treated conservatively. One case underwent complete spontaneous radiological resolution one month later, and the other one has remained neurological asymptomatic at follow-up. CONCLUSIONS Isolated asymptomatic ventricular entrapment with significant dilation after endoscopic colloid cyst resection is a rare occurrence which can be plausibly caused by scar tissue at the level of the foramen of Monro. Because they can have an indolent course with spontaneous resolution, conservative treatment is a viable option, with strict radiological and clinical follow - up. Given the rarity of the occurrence, further studies with larger cohorts are warranted to confirm the etiopathogenetic hypothesis and validate the clinical management.
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Affiliation(s)
- Alessandro Carretta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy.
| | - Matteo Zoli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Arianna Rustici
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
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Farahmand D, Stridh J, Ziegelitz D, Tisell M. Endoscopic versus open microsurgery for colloid cysts of the third ventricle. Br J Neurosurg 2023; 37:59-62. [PMID: 34034576 DOI: 10.1080/02688697.2021.1925872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The surgical approach for colloid cysts of the third ventricle mainly consists of endoscopic or microscopic approach but few studies compare the neurologic outcomes and complications related to the different approaches. We retrospectively reviewed our results after resection of colloid cysts of the third ventricle using endoscopic surgery (ES) compared to open microsurgery (OS). METHODS Fifty-one patients were included in the study of which 17 patients underwent ES. Colloid cyst size and Evans' index were evaluated on CT or MRI scans. Presenting symptoms, neurologic outcomes and complications were compared between the two groups and analysed using Fisher's exact test. Operative time and days of hospital stay were compared between the two groups, using independent sample t-test. The median follow-up time was 96 days and did not differ significantly between the groups. RESULTS Shorter mean operative time (p = 0.04) and fewer days of hospital stay (p < 0.01) were found in the endoscopic group compared to the open microsurgical group. Presenting symptoms, neurological outcomes and postoperative complications were similar in the two groups. CONCLUSIONS ES showed similar neurologic outcomes and complications compared to OS for colloid cysts of the third ventricle. ES showed significantly shorter operative times and hospital stays compared to OS.
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Affiliation(s)
- Dan Farahmand
- Department of Neurosurgery, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johannes Stridh
- Department of Neurosurgery, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Doerthe Ziegelitz
- Department of Neuroradiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
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Otamendi-Lopez A, Marenco-Hillembrand LC, De Biase G, Snyman C, Quiñones-Hinojosa A. Disease characteristics and patterns of familial colloid cyst of the third ventricle: An international survey of the Colloid Cyst Survivors Group. J Clin Neurosci 2022; 106:49-54. [DOI: 10.1016/j.jocn.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/18/2022] [Accepted: 09/28/2022] [Indexed: 11/15/2022]
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Late progression of incidental colloid cysts – Two case reports and a review of the literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Giantini-Larsen AM, Garton ALA, Villamater FN, Kuzan-Fischer CM, Savage NJ, Cunniff CM, Ross ME, Christos PJ, Stieg PE, Souweidane MM. Familial colloid cysts: not a chance occurrence. J Neurooncol 2022; 157:321-332. [PMID: 35243591 DOI: 10.1007/s11060-022-03966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Colloid cysts are rare, benign brain tumors of the third ventricle with an estimated population prevalence of 1 in 5800. Sudden deterioration and death secondary to obstructive hydrocephalus are well-described presentations in patients with a colloid cyst. Although historically conceptualized as driven by sporadic genetic events, a growing body of literature supports the possibility of an inherited predisposition. METHODS A prospective registry of patients with colloid cysts was maintained between 1996 and 2021. Data pertaining to a family history of colloid cyst was collected retrospectively; self-reporting was validated in each case by medical record or imaging review. Frequency of patients with a documented first-degree family member with a colloid cyst based on self-reporting was calculated. The rate of familial co-occurrence within our series was then compared to a systematic literature review and aggregation of familial case studies, as well as population-based prevalence rates of sporadic colloid cysts. RESULTS Thirteen cases with affected first-degree relatives were identified in our series. Of the entire cohort, 19/26 were symptomatic from the lesion (73%), 12/26 (46.2%) underwent resection, and 2/26 (7.7%) had sudden death from presumed obstructive hydrocephalus. The majority of transmission patterns were between mother and child (9/13). Compared with the estimated prevalence of colloid cysts, our FCC rate of 13 cases in 383 (3.4%) estimates a greater-than-chance rate of co-occurrence. CONCLUSION Systematic screening for FCCs may facilitate early recognition and treatment of indolent cysts, thereby preventing the rapid deterioration that can occur with an unrecognized third ventricular tumor. Furthermore, identifying a transmission pattern may yield more insight into the molecular and genetic underpinnings of colloid cysts.
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Affiliation(s)
- Alexandra M Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 625 E 68th St; Starr 651, New York, NY, 10065, USA
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew L A Garton
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 625 E 68th St; Starr 651, New York, NY, 10065, USA
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francis N Villamater
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 625 E 68th St; Starr 651, New York, NY, 10065, USA
| | | | - Nicole J Savage
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 625 E 68th St; Starr 651, New York, NY, 10065, USA
| | - Christopher M Cunniff
- Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - M Elizabeth Ross
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 625 E 68th St; Starr 651, New York, NY, 10065, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 625 E 68th St; Starr 651, New York, NY, 10065, USA.
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Comparison of microscopic and endoscopic resection of third-ventricular colloid cysts: A Systematic Review and Meta-Analysis. Clin Neurol Neurosurg 2022; 215:107179. [DOI: 10.1016/j.clineuro.2022.107179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/15/2023]
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Retrospective evaluation of endoscopic treatment in colloid cyst of the third ventricle. Wideochir Inne Tech Maloinwazyjne 2021; 16:604-611. [PMID: 34691312 PMCID: PMC8512511 DOI: 10.5114/wiitm.2021.103957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Endoscopic methods have gained a well-established position in surgical treatment of colloid cysts of third ventricle. However, the possibility of total tumor removal with this method and the long-term effectiveness of treatment are being questioned. Aim Personal twenty years’ experience in treatment of third ventricle colloid cysts is presented on the basis of retrospective analysis. Material and methods The study group included 58 patients diagnosed by neuroimaging (head CT/MRI) with third ventricle colloid cyst. Post-hospital follow-up ranged from 18 to 42 months. Long-term follow-up head CT/MRI was performed in 39 patients. Results The colloid cyst was removed totally in 47 (81%) patients. In 11 cases, the colloid cyst’s wall was tightly adherent to the roof of the third ventricle, which limited the radicality of the procedure. Sixteen patients demonstrated memory impairments, 4 patients epilepsy and another 2 akinetic mutism in the direct postoperative course. One patient died as a result of complications unrelated to the procedure. The average hospitalization was 5 days. In the late period after surgery, remission of the most, previously, reported ailments and symptoms has been reported. Surgical treatment for hydrocephalus was needed in 7 patients. In 3 cases cyst recurrence was diagnosed which required reoperation. Conclusions The endoscopic methods allow the total removal of a third ventricle colloid cyst in most patients. Leaving a small coagulated fragment of the cyst rarely results in its recurrence. This method results in effective treatment with a low complications rate, shortens hospitalization time and brings the patient a high level of satisfaction with a quick recovery.
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9
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Sayah A, Berkowitz F, Thakkar RS. The black rim susceptibility sign in the MRI evaluation of intracranial colloid cysts. J Neuroimaging 2021; 31:1028-1034. [PMID: 33930212 DOI: 10.1111/jon.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Colloid cysts are relatively rare intracranial lesions located in the rostral aspect of third ventricle. They may produce acute hydrocephalus, brain herniation, and death. On conventional MRI, the appearance of a colloid cyst varies depending on its composition. Small isointense cysts can be missed. The purpose of this study is to introduce a new sign, "black rim susceptibility" sign for the accurate diagnosis of colloid cyst on susceptibility weighted imaging (SWI). METHODS A retrospective case-control study consisted of 100 MRI brain scans (19 cases and 81 controls) performed from January 2012 to September 2018. Two fellowship trained neuroradiologists individually interpreted SWI sequences for the presence of the "black rim susceptibility" sign (thin rim of dark signal along the periphery of a rounded, hyperintense focus). RESULTS The sample was 43% male and 57% female, with an average age of 51.8 ± 17.7. Out of 19 cases, 9 had undergone surgery in which pathology had confirmed colloid cyst. Sensitivity, specificity, and accuracy for reader 1 was 94.8%, 98.8%, and 98% and for reader 2 was 89.5%, 100%, and 98%, respectively. Positive predictive value and negative predictive value for reader 1 was 94.7% and 98.8% and for reader 2 was 100% and 97.6%, respectively. Interrater correlation between the two readers was calculated with kappa of 0.93. CONCLUSION The black rim susceptibility appearance of colloid cyst on SWI is a novel description and an effective sign that can be used by radiologists for accurate diagnosis.
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Affiliation(s)
- Anousheh Sayah
- Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Frank Berkowitz
- Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Rashmi S Thakkar
- Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC, USA
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Elshamy W, Burkard J, Gerges M, Erginoglu U, Aycan A, Ozaydin B, Dempsey RJ, Baskaya MK. Surgical approaches for resection of third ventricle colloid cysts: meta-analysis. Neurosurg Rev 2021; 44:3029-3038. [PMID: 33590366 DOI: 10.1007/s10143-021-01486-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
Although outcome studies and systematic reviews have been published on the surgical treatment of third ventricle colloid cysts (TVCC), there are no meta-analyses that compare the outcomes for various surgical approaches. This meta-analysis assesses the outcomes and complications for transcortical, transcallosal, and endoscopic surgical approaches used to excise TVCCs. A meta-analysis of surgically excised TVCCs was performed with an assessment of outcome for transcortical, transcallosal, and endoscopic approaches. A random-effects model analyzed the extent of surgical excision. The analysis included reports that compared at least two of these surgical approaches, for a total of 11 studies comprising a population of 301 patients. The transcortical approach was associated with a higher incidence of complete excision compared to the endoscopic approach (OR = 0.137, p = 0.041), with no significant differences observed between transcortical and transcallosal approaches, and between transcallosal and endoscopic approaches. Comparison between endoscopic and pooled microsurgical approaches was also insignificant (OR = 0.22, p = 1). The risk of motor weakness was increased with the transcortical approach compared to the endoscopic approach (OR = 6.10, p = 0.018). There were no significant differences between transcortical and transcallosal approaches regarding newly onset seizures, and no significant mortality differences between all three approaches. This study demonstrates that microsurgical approaches are associated with a greater extent of resection compared to endoscopic approaches; however, best results are likely achieved based on the surgeon's expertise, flexibility, and case review.
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Affiliation(s)
- Walid Elshamy
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA.,Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jake Burkard
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Mina Gerges
- Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ufuk Erginoglu
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Abdurahman Aycan
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Burak Ozaydin
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA.
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Al-Saiari SA, Abdoh MG, Farag AA, Al-Orabi KM, Rawah EA, Brinji ZS, Mohammed THK, Khoudir MA. Atypical haemorrhagic colloid cyst: 2 case reports surgical management and review of literature. Int J Surg Case Rep 2020; 76:435-440. [PMID: 33207407 PMCID: PMC7586049 DOI: 10.1016/j.ijscr.2020.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Colloid cysts are benign cystic lesions located at the anterior part of the third ventricle mostly at the foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is exceedingly rare. Only 15 clinically diagnosed cases of haemorrhagic cysts were reported in the literature and 5 more cases on autopsy. Here we report two rare cases of a haemorrhagic colloid cyst describing the atypical radiological findings, the undertaken surgical procedures and histopathological results. PRESENTATION OF CASES We presented 2 cases of haemorrhagic third ventricle colloid cysts. First case is a 27-year-old male patient, presented with dizziness, nausea, vomiting and blurring of vision. He was operated by transcortical endoscopic transventricular excision of a third ventricular cyst and the insertion of external ventricular drain. The second patient is a 21-year-old male, presented with history of worsening headache for 1 month associated with blurring of vision. The patient had a transcortical microscopic, transventricular cyst excision. DISCUSSION Many questions regarding the best way to diagnose and manage such lesions remain unanswered. Hence, we summarize the relevant diagnostic images and best surgical techniques. CONCLUSION We concluded that, though exceedingly rare, colloid cyst can bleed and cause rapid deterioration in neurological status, thus, presence of atypical features should alert the physicians to consider atypical colloid cyst that would be valuable in surgical decision making whether endoscopic or microscopic.
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Affiliation(s)
- Sultan Ali Al-Saiari
- Neurosurgery Department, King Abdullah Medical City in Holy Capital, Saudi Arabia
| | - Mohammad Ghazi Abdoh
- Neurosurgery Department, King Abdullah Medical City in Holy Capital, Saudi Arabia
| | - Ahmed A Farag
- Neurosurgery Department, King Abdullah Medical City in Holy Capital, Saudi Arabia
| | | | | | - Zaina Siraj Brinji
- Neuroradiology Department, King Abdullah Medical City in Holy Capital, Saudi Arabia
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Khanpara SD, Day AL, Bhattacharjee MB, Riascos RF, Fernelius JP, Westmark KD. The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly. AJNR Am J Neuroradiol 2020; 41:1833-1840. [PMID: 32912876 DOI: 10.3174/ajnr.a6722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE While third ventricular colloid cysts may present as an incidental finding, they also harbor the potential to cause ventricular obstruction and sudden death. Herein we analyze the relationship between imaging appearance and the risk of obstructive ventriculomegaly. MATERIALS AND METHODS This is a retrospective review of the MR imaging appearance of 64 patients with colloid cysts, 46 of whom also had a CT scan, obtained by a tertiary hospital imaging report data base search over a 10-year period. Cysts were categorized by appearance on T2-FLAIR and correlated with patient age, cyst size, and the risk of obstructive ventriculomegaly. Histopathologic correlation was available for 28 cases. RESULTS The 64-patient cohort was 52% female, median age 50 years (range 10 to 99 years). Cysts hyperintense on T2-FLAIR (53.1%) were larger (P <.001), occurred in younger patients (P = .01), and had a higher risk of obstructive ventriculomegaly than homogeneously hypointense cysts (relative risk 6.18, 95% CI [2.04, 18.67]). Three patterns of T2 hyperintensity were identified: homogeneously hyperintense, hyperintense rim, and cysts with "dot sign." Although "dot sign" cysts were larger (P < .001), there was no significant difference in patient age or the risk of ventricular obstruction among T2 hyperintense cysts. Cyst wall histopathology did not vary with imaging appearance. CONCLUSIONS Hyperintensity on T2-FLAIR, whether homogeneous, rim, or "dot sign," is associated with larger cyst size and younger patient age, and is an imaging risk factor for obstructive ventriculomegaly. The hyperintense rim does not represent a thickened cyst wall.
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Affiliation(s)
- S D Khanpara
- Departments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
| | | | - M B Bhattacharjee
- Pathology (M.B.B.), McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - R F Riascos
- Departments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
| | - J P Fernelius
- Department of Quality and Outcomes Management (J.P.F.), Texas Children's Hospital, Houston, Texas
| | - K D Westmark
- Departments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
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Angelopoulou E, Koropouli E, Velonakis G, Koutsis G, Anagnostouli M, Tzartos I, Tzanetakos D, Stranjalis G, Kilidireas C, Evangelopoulos ME. Paroxysmal Lower Limb Tremor as a Rare Presentation of Colloid Cyst of the Third Ventricle: A Case Report and Literature Review. Open Neuroimag J 2020. [DOI: 10.2174/1874440002013010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
Colloid cysts of the third ventricle are benign intracranial tumors. They are most commonly presented with signs of intracranial hypertension due to obstructive hydrocephalus, including headache, nausea/vomiting and vision disturbances, whereas extrapyramidal symptoms such as tremor are very rare. Sudden death, due to abruptly developed hydrocephalus, can be also observed. Although paroxysmal symptomatology attributed to the intermittent obstruction of the foramen of Monro is considered the “classical” clinical presentation, it is rather the exception in clinical practice.
Case Report:
A 42-year-old woman with no medical history was admitted to the neurology department as suffering from a potential demyelinating disease due to episodes of paroxysmal tremor of her right lower limb and persistent mild gait instability, which presented 15 days prior to her arrival. She also complained of episodes of partially position-dependent bilateral headache over the last 10 years, as well as episodes of vertigo over the last 4 years. On arrival, her gait was shuffling and mildly wide-based and an intermittent tremor of her right lower limb was observed in supine and sitting positions, but not in a prone position. Brain magnetic resonance imaging (MRI) demonstrated a round cystic lesion of the third ventricle, accompanied by hydrocephalus with enlargement of lateral ventricles. MRI findings were highly indicative of a colloid cyst. The patient underwent resection of the mass and the tremor resolved after surgery.
Conclusion:
Given the greatly heterogeneous clinical presentation of colloid cysts, our case highlights the significance of the prompt diagnosis of this rare but potentially fatal cause of paroxysmal limb tremor.
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Calderón C, Fernandez-de Thomas RJ, De Jesus O. Familial Colloid Cysts of the Third Ventricle: Case Report and Literature Review. Asian J Neurosurg 2020; 15:414-417. [PMID: 32656143 PMCID: PMC7335152 DOI: 10.4103/ajns.ajns_332_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/21/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022] Open
Abstract
Colloid cysts of the third ventricle are rare lesions. To our knowledge, only 23 familial cases of colloid cysts have been reported in the literature. The country of origin of the patients with familial cases had not been previously studied as a group. A 49-year-old female patient from Puerto Rico and her 21-year-old daughter underwent surgical resection for colloid cysts within a period of 5 years. The daughter presented with symptomatic hydrocephalus, while the mother only had mild chronic headaches. The occurrence of a colloid cyst in this family prompted us to perform a literature review and tabulate all the familial cases. This report presents the 24th case of a familial colloid cyst, and the fourth involving a mother and daughter. Australia is the country with the largest amount of reported cases. For smaller countries such as Sweden and Finland, two cases had been reported for each of them. Due to the unlikely probability of familial colloid cyst occurring at random, a genetic component is likely to be involved. The occurrence of several reports from patients from Australia, Finland, Sweden, and Puerto Rico where the population is smaller or more segregated may also suggest a genetic inheritance. Screening of first-degree-related subjects is recommended for families in which two or more members are affected. The presence of a colloid cyst in a twin mandates neuroimaging in the other twin, as there are five familial cases in twins reported in the literature.
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Affiliation(s)
- Carlos Calderón
- Department of Surgery, Section of Neurosurgery, School of Medicine, University of Puerto Rico, San Juan, PR
| | | | - Orlando De Jesus
- Department of Surgery, Section of Neurosurgery, School of Medicine, University of Puerto Rico, San Juan, PR
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Fernández L, Areitio E, López JC, Gómez JJ, Elexpuru JA. Hemorrhagic colloid cyst of the third ventricle: A rare cause of colloid cyst growth and progressive hydrocephalus. Case report. Neurocirugia (Astur) 2020; 32:142-147. [PMID: 32430243 DOI: 10.1016/j.neucir.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute spontaneous bleeding within a colloid cyst of the third ventricle is extremely rare. Accordingly, is difficult to establish reliable prognostic factors, risk factors for obstructive hydrocephalus remain poorly defined, and there are no standard management strategies. CASE PRESENTATION 19-Year-old man with a colloid cyst of the third ventricle causing obstructive hydrocephalus is described, initially treated with partial endoscopic removal and ventriculo-peritoneal shunt placement. Serial neuroimaging follow-up showed gradual growth of the cyst due to clinically silent intracystic recurrent hemorrhage. Microsurgical transcallosal approach was performed and the cyst was totally resected. Pathological examination demonstrated hemorrhages of varying ages within the tumor. CONCLUSION Bleeding within a colloid cyst must be considered when neuroimaging follow-up shows cyst growth, even with no clinical events associated. Hemorrhagic changes within the colloid cyst should be considered in the surgical indication and approach.
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Affiliation(s)
- Leticia Fernández
- Department of Neurological Surgery, Hospital Universitario Basurto, Avenida Montevideo 18, 48013 Bilbao (Vizcaya, Basque Country), Spain.
| | - Eduardo Areitio
- Department of Neurological Surgery, Hospital Universitario Basurto, Avenida Montevideo 18, 48013 Bilbao (Vizcaya, Basque Country), Spain
| | - Juan Carlos López
- Department of Pathological Anatomy, Hospital Universitario Basurto, Avenida Montevideo 18, 48013 Bilbao (Vizcaya, Basque Country), Spain
| | - Juan José Gómez
- Department of Radiology, Hospital Universitario Basurto, Avenida Montevideo 18, 48013 Bilbao (Vizcaya, Basque Country), Spain
| | - José Antonio Elexpuru
- Department of Neurological Surgery, Hospital Universitario Basurto, Avenida Montevideo 18, 48013 Bilbao (Vizcaya, Basque Country), Spain
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Biju RD, O’ Sullivan J, Thomas A, Gan P, Muthu T. A rare case of intralesional haemorrhage of a benign aqueductal cyst after CSF diversion treatment. A case report and review of literature. Br J Neurosurg 2020:1-5. [DOI: 10.1080/02688697.2020.1742295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- R. D. Biju
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - J. O’ Sullivan
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - A. Thomas
- Department of Radiology, Waikato Hospital, Hamilton, New Zealand
| | - P. Gan
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - T. Muthu
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
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Muscas G, Battista F, Serra C, Boschi A, Noubari BA, Della Puppa A. Are familial colloid cysts of the third ventricle associated with a worse clinical course than sporadic forms? Case illustration and systematic literature review. J Neurosurg Sci 2020; 66:258-263. [PMID: 32043846 DOI: 10.23736/s0390-5616.20.04860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of asymptomatic colloid cysts is increasing due to the widespread use of neuroimaging tools. According to previous works, familial forms (within first-degree relatives) represent 5-25% of the cases, and it is not clear whether they display specific features influencing the clinical behavior of the disease. METHODS We reviewed the literature to extract data from papers dealing with familial colloid cysts. For comparison, previous series dealing with the natural history of sporadic cases were identified. Also, we present two more cases of familiar colloid cysts from our experience. RESULTS Fifty-one patients (23 reports, plus our cases) were analyzed. Familial cases showed a younger age at diagnosis (p=0.02) and fewer asymptomatic cases (p<0.001) compared to non- familial colloid cysts. The odds ratio and relative risk of needing surgery with a positive family history for surgical cyst removal were respectively 17.5 (CI: 1.6 - 197.4) and 1.9 (CI: 0.71 - 5.1). Screening of other family members identified further colloid cysts in 4% of families. CONCLUSIONS Familial colloid cysts show a higher percentage of younger and symptomatic patients compared to non-familiar forms. A positive family history for surgical evacuation is a predictor for a similar outcome. This could indicate a predisposition to an earlier formation and faster growth, and the need for a stricter follow-up in asymptomatic patients. If confirmed in the future, this could suggest a review of the criteria for cyst treatment and extend the surgical indication to asymptomatic familial cases.
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Affiliation(s)
- Giovanni Muscas
- Department of Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy -
| | - Francesca Battista
- Department of Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Carlo Serra
- Department of Neurosurgery, Zurich University Hospital, Zurich, Switzerland
| | - Andrea Boschi
- Department of Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Bahman A Noubari
- Department of Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
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Inchoate guidelines of endoscopic resection of colloid cysts. J Clin Neurosci 2019; 71:1-8. [PMID: 31839383 DOI: 10.1016/j.jocn.2019.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022]
Abstract
Colloid cyst are cystic lesions in the third ventricle and could render patients asymptomatic. However, there is an inherent risk of symptomatic progression, acute decompensation, and sudden death. Therefore, there is no clear consensus as how to observe or when to treat a newly diagnosed patient with a colloid cyst. The authors' objective is to identify the risk factors and then develop a risk stratification score to guide neurosurgeons during acute or chronic presentation. Radiological imaging characteristics have been outlined for the risk stratification as well preoperative evaluation. A baseline neuropsychological evaluation is helpful to obtain during an incidental presentation because history and neurological examination could be inconclusive in these cases. Radiological imaging with an MRI brain scan plays a vital role for the initial screening (determination of the cyst size, exact location, and the imaging characteristics) as well as for the preoperative planning. Stereotactic guidance is a high yield, followed by neuroendoscopic resection of the colloid cyst has been an established approach to resect these lesions. Modified colloid cyst risk scoring (mCCRS) system is robust and detailed for the optimal risk stratification of colloid cyst presentation. Stereotactic guided neuroendoscopic resection of the colloid cyst is a safe and efficacious approach to manage these lesions. The intended use, crucial steps involved, and the limitations of the technique have been discussed especially with a focus on the recurrence. Moreover, a comprehensive treatment algorithm has been presented.
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Chakravarthi SS, Kassam AB, Fukui MB, Monroy-Sosa A, Rothong N, Cunningham J, Jennings JE, Guenther N, Connelly J, Kaemmerer T, Nash KC, Lindsay M, Rissell J, Celix JM, Rovin RA. Awake Surgical Management of Third Ventricular Tumors: A Preliminary Safety, Feasibility, and Clinical Applications Study. Oper Neurosurg (Hagerstown) 2019; 17:208-226. [DOI: 10.1093/ons/opy405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 02/07/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUNDEndoscopic and microneurosurgical approaches to third ventricular lesions are commonly performed under general anesthesia.OBJECTIVETo report our initial experience with awake transsulcal parafascicular corridor surgery (TPCS) of the third ventricle and its safety, feasibility, and limitations.METHODSA total of 12 cases are reviewed: 6 colloid cysts, 2 central neurocytomas, 1 papillary craniopharyngioma, 1 basal ganglia glioblastoma, 1 thalamic glioblastoma, and 1 ependymal cyst. Lesions were approached using TPCS through the superior frontal sulcus. Pre-, intra-, and postoperative neurocognitive (NC) testing were performed on all patients.RESULTSNo cases required conversion to general anesthesia. Awake anesthesia changed intraoperative management in 4/12 cases with intraoperative cognitive changes that required port re-positioning; 3/4 recovered. Average length of stay (LOS) was 6.1 d ± 6.6. Excluding 3 outliers who had preoperative NC impairment, the average LOS was 2.5 d ± 1.2. Average operative time was 3.00 h ± 0.44. Average awake anesthesia time was 5.05 h ± 0.54. There were no mortalities.CONCLUSIONThis report demonstrated the feasibility and safety of awake third ventricular surgery, and was not limited by pathology, size, or vascularity. The most significant factor impacting LOS was preoperative NC deficit. The most significant risk factor predicting a permanent NC deficit was preoperative 2/3 domain impairment combined with radiologic evidence of invasion of limbic structures – defined as a “NC resilience/reserve” in our surgical algorithm. Larger efficacy studies will be required to demonstrate the validity of the algorithm and impact on long-term cognitive outcomes, as well as generalizability of awake TPCS for third ventricular surgery.
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Affiliation(s)
- Srikant S Chakravarthi
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Amin B Kassam
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Melanie B Fukui
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Alejandro Monroy-Sosa
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Nichelle Rothong
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Joseph Cunningham
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Jonathan E Jennings
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Neil Guenther
- Department of Anesthesiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Jeremy Connelly
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Tobias Kaemmerer
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Kenneth C Nash
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Janie Rissell
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Juanita M Celix
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Richard A Rovin
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
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Al Abdulsalam HK, Ajlan AM. Hemorrhagic colloid cyst. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2018; 23:326-333. [PMID: 30351291 PMCID: PMC8015560 DOI: 10.17712/nsj.2018.4.20180051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022]
Abstract
Colloid cysts are cystic lesions that are usually located in the anterior portion of the third ventricle near the foramen of Monro. Rarely, hemorrhagic cysts can lead to acute obstructive hydrocephalus or sudden death. We herein report 2 cases and a review literature. We examine a 47-year old male who presented with progressive headache and a 55-year old male who presented with progressive memory disturbance and unsteady gait. Both cases demonstrated typical imaging features of hemorrhagic colloid cyst, and were histopathologically confirmed. Total excision was achieved in both cases with good outcomes. Hemorrhagic colloid cysts are rare; however, bleeding tendencies should be carefully considered in patients with these cysts. The degree of rapidity with which clinical deterioration occurs may play a major role in the preferred treatment approach and subsequent outcomes.
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Affiliation(s)
- Hissah K. Al Abdulsalam
- From the Division of Neurosurgery (Alabdulsalam, Ajlan), King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrazag M. Ajlan
- From the Division of Neurosurgery (Alabdulsalam, Ajlan), King Saud University, Riyadh, Kingdom of Saudi Arabia
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21
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Factors influencing outcome in patients with colloid cysts who present with acute neurological deterioration. J Clin Neurosci 2018; 54:88-95. [DOI: 10.1016/j.jocn.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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Natural history of incidental colloid cysts of the third ventricle: A systematic review. J Clin Neurosci 2018; 53:122-126. [DOI: 10.1016/j.jocn.2018.04.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/22/2018] [Indexed: 11/23/2022]
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Heifets BD, Crawford E, Jackson E, Brodt J, Jaffe RA, Burbridge MA. Case Report of an Awake Craniotomy in a Patient With Eisenmenger Syndrome. A A Pract 2018; 10:219-222. [PMID: 29708913 DOI: 10.1213/xaa.0000000000000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We present a detailed report of an awake craniotomy for recurrent third ventricular colloid cyst in a patient with severe pulmonary arterial hypertension in the setting of Eisenmenger syndrome, performed 6 weeks after we managed the same patient for a more conservative procedure. This patient has a high risk of perioperative mortality and may be particularly susceptible to perioperative hemodynamic changes or fluid shifts. The risks of general anesthesia induction and emergence must be balanced against the risks inherent in an awake craniotomy on a per case basis.
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Affiliation(s)
- Boris D Heifets
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Eshra MA. Endoscopic management of third ventricular colloid cysts in mildly dilated lateral ventricles. Neurosurg Rev 2018. [PMID: 29527620 DOI: 10.1007/s10143-018-0956-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Colloid cysts of the third ventricle are considered as benign lesions. The clinical manifestations are not clear in most of cases. Many treatment options are available and endoscopic removal of the cysts proves to be a very successful method especially if the lateral ventricles are moderately or severely dilated. Sometimes, we faced cases with non- or mildly dilated ventricles which may add more risks to the operation, limit the radicality of removal, or abort the procedure entirely. Sixteen cases of colloid cyst with mildly dilated ventricles were operated upon between 2008 and 2016 using the rigid endoscopic system. Twelve were female and four were male. Their ages were between 17 and 40 years old. Headaches and epileptic fits were the presenting symptoms in 13 cases and 2 cases respectively. One case was asymptomatic. The patients were followed up from 1 to 4 years. Total removal in 12 cases and evacuation of the contents and partial removal in 4 cases. Mild transient complications occurred in the form of fever in seven cases, vomiting in four cases or short-term recent memory loss in three cases. No deaths occurred due to the procedures. Working endoscopically in enlarged ventricles is very effective and easy; however, small sized ventricles do not prevent safe and effective complete removal of colloid cysts. Cases with residual cyst wall do not suffer from recurrence.
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Affiliation(s)
- Mohamed A Eshra
- Department of neurosurgery, Faculty of Medicine, Alexandria University, Champillion St., Elazaritta, Alexandria, Egypt.
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Samadian M, Ebrahimzadeh K, Maloumeh EN, Jafari A, Sharifi G, Shiravand S, Digaleh H, Rezaei O. Colloid Cyst of the Third Ventricle: Long-Term Results of Endoscopic Management in a Series of 112 Cases. World Neurosurg 2018; 111:e440-e448. [DOI: 10.1016/j.wneu.2017.12.093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Microsurgical Treatment of Colloid Cysts of the Third Ventricle. World Neurosurg 2017; 105:678-688. [PMID: 28619498 DOI: 10.1016/j.wneu.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study analyzes the results of surgical treatment in 377 patients with colloid cysts (CCs) of the third ventricle who were treated at the Burdenko Neurosurgery Institute from 1981 to 2015. Operations were performed by a single surgeon (the first author of the article). METHODS The transcallosal approach was used to remove CCs in 97% of cases. Total cyst removal was performed in 96% of cases (in 4% of cases, a small cyst capsule fragment was left on the veins and fornix); in 3 cases, the cyst recurred, which required its repeated removal. RESULTS Hydrocephalus symptoms regressed in 98% of patients. The most frequent complications in the early postoperative period were memory impairments of varying severity, with a tendency to regress by the time of discharge. Two patients had an intraventricular hematoma, which required operative exploration in 1 patient. There were 4 cases of meningitis (including 1 shunt-associated meningitis) and 5 cases of transient pyramidal insufficiency. CONCLUSIONS We made a preliminary assessment of the reasonability of the infratentorial supracerebellar approach for removal of CCs in 10 cases.
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Connolly ID, Johnson E, Lamsam L, Veeravagu A, Ratliff J, Li G. Microsurgical vs. Endoscopic Excision of Colloid Cysts: An Analysis of Complications and Costs Using a Longitudinal Administrative Database. Front Neurol 2017; 8:259. [PMID: 28649225 PMCID: PMC5465269 DOI: 10.3389/fneur.2017.00259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Open microsurgical and endoscopic approaches are the two main surgical options for excision of colloid cysts. Controversy remains as to which is superior. Previous studies consist of small cohort sizes. This topic has not been investigated using national administrative claims data which benefits from larger patient numbers. METHODS Current Procedural Terminology (CPT) and International Classification of Disease version 9 (ICD-9) coding at inpatient visit was used to select for index surgical procedures corresponding to microsurgical or endoscopic excision of colloid cysts. Comorbidities, costs, and complications were collected. RESULTS We identified a total of 483 patients. In all, 240 were from the microsurgical cohort and 243 were from the endoscopic cohort. The two groups displayed similar demographic and comorbidity profiles. Thirty-day post-operative complications were also similar between groups with the exception of seizures and thirty-day readmissions, both higher in the open surgical cohort. The seizure rates were 14.7 and 5.4% in the microsurgical and endoscopic cohorts, respectively (p = 0.0011). The thirty-day readmission rates were 17.3 and 9.6% in the microsurgical and endoscopic cohorts, respectively (p = 0.0149). Index admission costs and 90-day post discharge payments were higher in patients receiving microsurgical excision. CONCLUSION An analysis of administrative claims data revealed few differences in surgical complications following colloid cyst excision via microsurgical and endoscopic approaches. Post-operative seizures and thirty-day readmissions were seen at higher frequency in patients who underwent microsurgical resection. Despite similar complication profiles, patients undergoing microsurgical excision experienced higher index admission costs and 90-day aggregated costs suggesting that complications may have been more severe in this group.
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Affiliation(s)
- Ian David Connolly
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Layton Lamsam
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
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Buklina SB, Konovalov AN, Pitskhelauri DI, Shkarubo MA, Poddubskaya AA, Kolycheva MV. [A clinical and neuropsychological study of patients before and after resection of third ventricle colloid cysts]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:28-37. [PMID: 28524123 DOI: 10.17116/neiro201781228-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The literature lacks studies of cognitive impairments in large groups of patients after resection of third ventricle colloid cysts. AIM To evaluate cognitive impairments in patients before and after resection of third ventricle colloid cysts. MATERIAL AND METHODS We performed a clinical and neuropsychological study of 52 patients with third ventricle colloid cysts using the Luria method (1962). Forty three patients were examined before and after cyst resection in the early postoperative period (three patients in this group were also examined in a long-term period of 3-7 months after surgery). Forty one patients were operated on using the transcallosal approach, and two patients were operated on using the subtentorial-supracerebellar transchoroidal approach. The other patients were examined only before or after surgery. The patients' age ranged from 14 to 61 years; the mean age was 33.8 years; the median age was 29 years. RESULTS On examination before surgery, cognitive impairments were minimal in 5 patients without clear signs of hydrocephalus. Impairments of memory and dynamic praxis, mild spatial disorders, and psychological inertia were observed in other patients with hydrocephalus. There was no significant difference in the state of cognitive functions between patients with and without stagnation in the fundus. On examination on day 3-6 after transcallosal surgery, several groups of patients were identified. Eight patients had an improvement in cognitive functions, which might be related to postoperative resolution of hydrocephalus. In 15 patients, changes in mnestic functions were insignificant. This group consisted of the youngest patients with a median age of 24 years. Korsakoff syndrome and disorientation were detected in 5 patients. This was the oldest age group, with a median age of 48 years. In other 13 patients, aggravation of mnestic disorders was moderate. Similar memory impairments were detected in the case of the subtentorial-supracerebellar approach. Memory disorders progressively regressed in all patients. CONCLUSION Postoperative memory impairment of a varying degree was found in 21 out of 43 patients, with adhesions between the cyst capsule and fornix being observed only in 5 patients. In this case, no injury to the fornix was intraoperatively observed. We discuss the role of the age factor, cyst size, and technical surgical difficulties in the pathogenesis of memory disorders in the absence of injury to the calvarium during colloid cyst resection.
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Affiliation(s)
- S B Buklina
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - M A Shkarubo
- Burdenko Neurosurgical Institute, Moscow, Russia
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Brostigen CS, Meling TR, Marthinsen PB, Scheie D, Aarhus M, Helseth E. Surgical management of colloid cyst of the third ventricle. Acta Neurol Scand 2017; 135:484-487. [PMID: 27349743 DOI: 10.1111/ane.12632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study of third ventricular colloid cysts (TVCC) from a defined population was to estimate the incidence, the presenting features, the surgical treatment, the treatment related complications, and the clinical and surgical outcomes. METHODS A reprospective study of 32 consecutive primary surgeries for TVCC was performed at Oslo University Hospital in the time period 2002-2015. RESULTS The estimated incidence rate for TVCC was 0.9 per million. Mean age was 41 years and the male-to-female ratio was 1:1.5. The most common presenting symptoms were headache (100%), ataxia (25%), reduced level of consciousness (22%), and impaired vision (19%). The surgical mortality was 0%. Gross total resection (GTR) was achieved in 69% based on intraoperative findings and in 81% based on postoperative imaging. The rate of surgery-related complications was 13%. There was no statistically significant difference between microsurgery and endoscopic surgery with respect to surgery-related complications and grade of resection. At time of follow-up, all patients were able to care for themselves. CONCLUSIONS Due to the risk of acute neurological deterioration and sudden death, surgical treatment is recommended for patients with symptomatic TVCC. This study shows that surgical resection can be performed with a fairly low risk and with a good long-term outcome.
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Affiliation(s)
| | - T. R. Meling
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Neurosurgery; Oslo University Hospital; Oslo Norway
| | - P. B. Marthinsen
- Department of Neuroradiology; Oslo University Hospital; Oslo Norway
| | - D. Scheie
- Department of Neuropathology; Oslo University Hospital; Oslo Norway
- Rigshospitalet; Copenhagen Denmark
| | - M. Aarhus
- Department of Neurosurgery; Oslo University Hospital; Oslo Norway
| | - E. Helseth
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Neurosurgery; Oslo University Hospital; Oslo Norway
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Beaumont TL, Limbrick DD, Rich KM, Wippold FJ, Dacey RG. Natural history of colloid cysts of the third ventricle. J Neurosurg 2016; 125:1420-1430. [PMID: 26967781 DOI: 10.3171/2015.11.jns151396] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-prediction model was defined using bootstrapped logistic regression. Predictive factors were then combined into a simple 5-point clinical scale referred to as the Colloid Cyst Risk Score (CCRS), and this was evaluated with receiver-operator characteristics. RESULTS The study included 163 colloid cysts, more than half of which were discovered incidentally. More than half of the incidental cysts (58%) were followed with surveillance neuroimaging (mean follow-up 5.1 years). Five patients with incidental cysts (8.8%) progressed and underwent resection. No patient with an incidental, asymptomatic colloid cyst experienced acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly half (46.2%) of symptomatic patients presented with hydrocephalus. Eight patients (12.3%) presented acutely, and there were 2 deaths due to obstructive hydrocephalus and herniation. The authors identified several factors that were strongly correlated with the 2 outcome variables and defined third ventricle risk zones where colloid cysts can cause obstructive hydrocephalus. No patient with a lesion outside these risk zones presented with obstructive hydrocephalus. The CCRS had significant predictive capacity for symptomatic clinical status (area under the curve [AUC] 0.917) and obstructive hydrocephalus (AUC 0.845). A CCRS ≥ 4 was significantly associated with obstructive hydrocephalus (p < 0.0001, RR 19.4). CONCLUSIONS Patients with incidentally discovered colloid cysts can experience both lesion enlargement and symptom progression or less commonly, contraction and symptom regression. Incidental lesions rarely cause acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly one-half of patients with symptomatic colloid cysts present with obstructive hydrocephalus, which has an associated 3.1% risk of death. The CCRS is a simple 5-point clinical tool that can be used to identify symptomatic lesions and stratify the risk of obstructive hydrocephalus. External validation of the CCRS will be necessary before objective surgical indications can be established. Surgical intervention should be considered for all patients with CCRS ≥ 4, as they represent the high-risk subgroup.
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Affiliation(s)
| | | | | | - Franz J Wippold
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Abed Rabbo F, Simon A, Ben Salem D, Seizeur R. Oculomotor Nerve Palsy Complicates Third Ventricle Colloid Cyst Endoscopic Removal: Case Report. World Neurosurg 2016; 90:700.e13-700.e17. [PMID: 26898492 DOI: 10.1016/j.wneu.2016.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A colloid cyst is a rare benign tumor. If indicated, surgical treatment can be realized using a microsurgical technique or an endoscopic technique. We report an uncommon complication of a third ventricle colloid cyst endoscopic removal. CASE DESCRIPTION The cyst was incidentally discovered on computed tomography scan workup for mild head trauma in a 20-year-old male. Minor headache and minor memory loss were noted on clinical examination. Magnetic resonance imaging workup revealed obstructive hydrocephaly of the lateral ventricles associated with left uncal herniation. Surgery was uneventful. However, left oculomotor palsy was noted postoperatively. Workup revealed oculomotor nerve injury and isolated left mammillary body ischemia, secondary to worsened uncal herniation. This worsening might be caused by acute left ventricle hydrocephaly ascribed to interventricular foramen obstruction during cyst removal. CONCLUSION Therefore, in similar presentation, realizing septum fenestration before cyst removal should relieve the pressure in the lateral ventricles thus decreasing the risk of herniation.
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Affiliation(s)
- Francis Abed Rabbo
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France; Laboratoire d'Anatomie, Faculté de Médecine, Université de Brest, France; Laboratoire de traitement de l'information médicale, LaTIM UMR1101, France.
| | - Alexandre Simon
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France
| | - Douraïed Ben Salem
- Laboratoire de traitement de l'information médicale, LaTIM UMR1101, France; Service de Radiologie, Hôpital Cavale Blanche, CHRU Brest, France
| | - Romuald Seizeur
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France; Laboratoire d'Anatomie, Faculté de Médecine, Université de Brest, France; Laboratoire de traitement de l'information médicale, LaTIM UMR1101, France
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Weaver KJ, McCord M, Neal D, Bova F, Rajon D, Quinones-Hinojosa A, Rahman M. Do tumor and ventricular volume predict the need for postresection shunting in colloid cyst patients? J Neurosurg 2016; 125:585-90. [PMID: 26824370 DOI: 10.3171/2015.9.jns151183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many colloid cyst patients present with obstructive hydrocephalus that resolves after resection of the cyst. However, a proportion of patients with these cysts will require cerebrospinal fluid shunting after tumor resection, despite resolution of the obstruction at the foramina of Monro. The goal of this study was to determine if colloid cyst size or preoperative ventricular volume predicted the need for postresection shunting. METHODS In a retrospective study design, ICD-9 codes 742.2 (colloid cyst) and 348.0 (brain cyst) were used to identify patients who had undergone resection of a colloid cyst at the University of Florida over the last 20 years. Preoperative imaging (CT or MRI) with a stereotactic software program developed at the University of Florida was used to measure volumes of the colloid cyst and the lateral ventricles. The relationships among ventricular volume, colloid cyst volume, and postoperative shunting were analyzed. RESULTS The number of patients included in the study was 67, and their mean age was 37.7 years. Forty percent of the patients were female. Overall, 49.2% of the patients had a transcallosal approach, 35.8% a transcortical approach, and 14.9% an endoscope-assisted surgery. Mean preoperative ventricular volume was 76.5 cc in patients who never received a ventriculoperitoneal shunt (VPS) and 98.1 cc in those who were eventually treated with a VPS (p = 0.305). Patients with a postoperative VPS had an initial mean colloid cyst volume of 1.8 cc compared with 0.9 cc in patients without a VPS postoperatively (p = 0.019). Patients with colloid cysts larger than 0.6 cc (1-cm diameter) had a 12.8 increased odds of needing a VPS postoperatively (95% CI 1.81-275). CONCLUSIONS Larger colloid cysts are associated with an increased need for postresection shunting independent of preoperative ventricular size. Prospective studies of patients with colloid cysts are necessary to further identify risks of permanent hydrocephalus.
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Affiliation(s)
- Kristin J Weaver
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Matthew McCord
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Dan Neal
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | | | | | | | - Maryam Rahman
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
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Lustgarten L. Is there room for stereotactic radiosurgery as an option for third ventricular colloid cysts in patients refusing surgery? A case report and some therapeutic considerations. Surg Neurol Int 2015; 6:S402-5. [PMID: 26500803 PMCID: PMC4596050 DOI: 10.4103/2152-7806.166175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Colloid cysts of the third ventricle are epithelium-lined mucus-filled cysts usually occurring in the anterosuperior third ventricle. They are benign, slow-growing lesions but with the risk of sudden death. Treatment alternatives for symptomatic cysts include stereotactic aspiration, microsurgical or endoscopic approaches, and shunts for hydrocephalus. CASE DESCRIPTION The current case describes a patient presenting with hydrocephalus and a colloid cyst. A ventriculoperitoneal shunt was placed as the patient refused a definitive surgical procedure for the removal of the cyst, and stereotactic radiosurgery was then performed. CONCLUSIONS Stereotactic radiosurgery may be a reasonable alternative with minimal risks in those patients harboring a third ventricle colloid cyst refusing a definitive surgical procedure for resection of the cyst.
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Affiliation(s)
- Leonardo Lustgarten
- Department of Neurosurgery, Hospital Clinicas Caracas, Caracas, Venezuela
- Department of Radiation Oncology, Hospital Clinicas Caracas, Caracas, Venezuela
- Department of Gammaknife Unit, CDD Las Mercedes, Caracas, Venezuela
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Combination of Neuroendoscopic and Stereotactic Procedures for Total Resection of Colloid Cysts with Favorable Neurological and Cognitive Outcomes. World Neurosurg 2015; 85:205-14. [PMID: 26348564 DOI: 10.1016/j.wneu.2015.08.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/30/2015] [Accepted: 08/31/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite a wide range of surgical procedures, an unresolved debate remains regarding which attempt is optimal for the treatment of colloid cysts in the third ventricle. In this article, we present a new combination of stereotactic and endoscopic techniques. METHODS This prospective study includes 27 consecutive patients with symptomatic primary and recurrent colloid cysts. All cysts were removed via a neuroendoscope through a rostral transfrontal, transforaminal approach. The endoscope was supported by an additional cannula fixed in the stereotactic frame. Both tools were inserted into one lateral ventricle through two separate burr holes using stereotactic guidance. RESULTS The median operating time was 135 minutes. All cysts were removed completely, and no mortality or permanent complications related to surgery occurred. The mean time of observation was 43.5 months (range, 3-78 months), and no clinical or radiologic recurrences were observed. One patient with a history of an infected ventriculoperitoneal shunt did not improve after cyst removal, but improved after subsequent reimplantation of the shunt. In all other cases, symptoms resolved (67%) or decreased (30%). Cognitive functions improved or remained unchanged in all 10 elective cases examined neuropsychologically before and after surgery. CONCLUSIONS The techniques we describe for removal of colloid cysts are safe and effective, even for recurrent cases, and they provide 100% total resection, favorable cognitive outcomes, low risk of recurrence, and low risk of morbidity. The disadvantages of this method are a longer time for surgery and the need for more complex instrumentation compared with conventional endoscopic resection.
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Niknejad HR, Samii A, Shen SH, Samii M. Huge familial colloid cyst of the third ventricle: An extraordinary presentation. Surg Neurol Int 2015; 6:S349-53. [PMID: 26236556 PMCID: PMC4521314 DOI: 10.4103/2152-7806.161416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background: Since the use of computed tomography and magnetic resonance imaging, colloid cysts (CCs) are discovered more frequently and subsequently their true incidence exceeds the numbers previously estimated. In 1986, the first familial case was reported in two identical twin brothers. To date, a total of 17 of these cases have been reported, all differing in the pattern of affected family members. Case Description: Here, we describe a unique presentation of a familial case and review the relevant literature on CCs and their natural history to improve our understanding of these cases. Conclusion: Familial CC can present in various patterns, sizes, and forms. A genetic factor is likely to be responsible in these cases, and further research is warranted to clarify this phenomenon.
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Affiliation(s)
| | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, D-30625 Hannover, Germany
| | - Shang-Hang Shen
- Department of Neurosurgery, International Neuroscience Institute, D-30625 Hannover, Germany
| | - Majid Samii
- Department of Neurosurgery, International Neuroscience Institute, D-30625 Hannover, Germany
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Abstract
In this case report we describe colloid cysts in the third ventricles of monozygotic twin sisters. They were 26 years old when their condition was discovered. One woman was admitted to us on an emergency basis, with signs of high intracranial pressure such as unconsciousness and extension posturing. Her sister was also brought to the hospital since she had a history of attacks of headache. They were both operated with removal of the colloid cysts, and the clinical courses are described in the case report. In reviewing the literature another 30 familial cases were found. Of these were two pairs of monozygotic and one pair of dizygotic twins.
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Affiliation(s)
| | - Edith Popek
- Department of Neurology, Örebro University Hospital, Örebro, Sweden
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Grondin RT, Hader W, MacRae ME, Hamilton MG. Endoscopic Versus Microsurgical Resection of Third Ventricle Colloid Cysts. Can J Neurol Sci 2014; 34:197-207. [PMID: 17598598 DOI: 10.1017/s0317167100006041] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Ron T Grondin
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Foothills Hospital, Alberta, Canada
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Symss NP, Ramamurthi R, Kapu R, Rao SM, Vasudevan MC, Pande A, Cugati G. Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: An analysis of 80 cases. Asian J Neurosurg 2014; 9:51-7. [PMID: 25126118 PMCID: PMC4129577 DOI: 10.4103/1793-5482.136708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Object: The objective of the present study is to analyze the complications and their avoidance in a series of 80 patients operated by transcallosal transforaminal approach to colloid cysts of the anterior third ventricle. Materials and Methods: The surgical outcome and complications of 80 patients operated by transcallosal transforaminal approach for colloid cysts in the anterior third ventricle was analyzed. A detailed pre- and post-operative neurological assessment was done in all patients. Neurocognitive assessment of corpus callosal function was done in the last 22 cases. CT scan of the brain was done in all patients, before and after surgery. Results: All patients underwent transcallosal transforaminal approach. Total excision of the lesion was achieved in 79 patients and subtotal in one. The complications encountered were postoperative seizures in six, acute hydrocephalus in four, venous cortical infarct in four, transient hemiparesis in four, transient memory impairment, especially for immediate recall in nine, mutism in one, subdural hematoma in one, meningitis in three, and tension pneumocephalus in one patient. There were two mortalities. There was no incidence of postoperative disconnection syndrome. Conclusion: Colloid cyst is surgically curable. With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease. With increasing experience, most of the complications are avoidable. The limited anterior callosotomy does not result in disconnection syndromes.
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Affiliation(s)
- Nigel P Symss
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Ravi Ramamurthi
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Ravindranath Kapu
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Santhosh Mohan Rao
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Madabushi Chakravarthy Vasudevan
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Anil Pande
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Goutham Cugati
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
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Ferreira CD, Matushita H, Silva BRD, Netto AU, Correia LG, Holanda MMDA, Santos RHP. Proposal of a new method to induce ventricular system dilation to simulate the features of hydrocephalus and provide an anatomical model for neuroendoscopy training. Childs Nerv Syst 2014; 30:1209-15. [PMID: 24389583 DOI: 10.1007/s00381-013-2346-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Create an anatomical model which simulates the real condition of a hydrocephalus and which can be used as a tool in the training of neurosurgeons in neuroendoscopy techniques and anatomical structure study. METHODS Case-control type study, with an experimental group consisting of ten brains, in which the injection of distilled water was performed; and the control group consisting of three brains with saline solution. Inclusion criteria were brains with no history of contagious diseases or traumatic injury. RESULTS t student test showed that the relation between frontal horn and internal frontal diameter (FH/ID), with an average of 13 % before the experiment, had a significant difference (t = -3.47, df = 9, p < 0.01) from the relation after the subsequent experiment with an average of 20 %. The Evan's index also showed a significant difference (t = -3.57, df = 9, p < 0.01) with an initial and final average of 12 % and 19 %, respectively. Friedman test showed significant difference of the size of the temporal horn before and after the experiment (f = 8.1, df = 1, p < 0.01), indicating that there was significant increase of the temporal horn. CONCLUSION The adequate use of the anomalous chemical-physical characteristics of the water molecule may provide a good mechanism to expand the ventricular cavity, in order to create an experimental model of hydrocephalus. The endoscope may be introduced by the usual ways, allowing anatomical observation and simulation of the same tactile sensitivity that one would find during the actual procedure.
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Iacoangeli M, di Somma LGM, Di Rienzo A, Alvaro L, Nasi D, Scerrati M. Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts. J Neurosurg 2014; 120:1471-6. [PMID: 24605835 DOI: 10.3171/2014.1.jns131102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Colloid cysts are histologically benign lesions whose primary goal of treatment should be complete resection to avoid recurrence and sudden death. Open surgery is traditionally considered the standard approach, but, recently, the endoscopic technique has been recognized as a viable and safe alternative to microsurgery. The endoscopic approach to colloid cysts of the third ventricle is usually performed through the foramen of Monro. However, this route does not provide adequate visualization of the cyst attachment on the tela choroidea. The combined endoscopic transforaminal-transchoroidal approach (ETTA), providing exposure of the entire cyst and a better visualization of the tela choroidea, could increase the chances of achieving a complete cyst resection. Between April 2005 and February 2011, 19 patients with symptomatic colloid cyst of the third ventricle underwent an endoscopic transfrontal-transforaminal approach. Five of these patients, harboring a cyst firmly adherent to the tela choroidea or attached to the middle/posterior roof of the third ventricle, required a combined ETTA. Postoperative MRI documented a gross-total resection in all 5 cases. There were no major complications and only 1 patient experienced a transient worsening of the memory deficit. To date, no cyst recurrence has been observed. An ETTA is a minimally invasive procedure that can allow for a safe and complete resection of third ventricle colloid cysts, even in cases in which the lesions are firmly attached to the tela choroidea or located in the middle/posterior roof of the third ventricle.
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Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy
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Diyora B, Nayak N, Kukreja S, Sharma A. Hemorrhagic colloid cyst: Case report and review of the literature. Asian J Neurosurg 2014; 8:162. [PMID: 24403960 PMCID: PMC3877504 DOI: 10.4103/1793-5482.121689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Colloid cysts are cystic lesions located at the anterior part of third ventricle, close to foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is very rare. On literature review, we found only six cases of hemorrgic colloid cyst; among them, four were diagnosed at postmortem examination. We report a rare case of a hemorrhagic colloid cyst in a young lady who presented with sudden onset severe headache and vomiting. Computed tomography (CT) scan showed isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. The lesion was not enhancing on contrast. Magnetic resonance imaging (MRI) brain revealed a well-defined cystic mass lesion located at the foramen of Monro which was hyperintense on T1 and hypointense on T2-weighted images. Excision of the colloid cyst was performed which revealed hemorrhagic clot instead of colloid material. Histopathological examination revealed a colloid cyst with hemorrhage. We believe that this is the first such reported case of successful clinical outcome following early diagnosis and excision of a hemorrhagic colloid cyst in an adult.
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Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, L. T. M. G. Hospital, Mumbai, Maharashtra, India
| | - Naren Nayak
- Department of Neurosurgery, L. T. M. G. Hospital, Mumbai, Maharashtra, India
| | - Sanjay Kukreja
- Department of Neurosurgery, L. T. M. G. Hospital, Mumbai, Maharashtra, India
| | - Alok Sharma
- Department of Neurosurgery, L. T. M. G. Hospital, Mumbai, Maharashtra, India
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Benoiton LA, Correia J, Kamat AS, Wickremesekera A. Familial colloid cyst. J Clin Neurosci 2013; 21:533-5. [PMID: 24308955 DOI: 10.1016/j.jocn.2013.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 08/04/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022]
Abstract
Colloid cysts of the third ventricle are rare benign tumours that can present as symptomatic hydrocephalus or be an incidental finding on imaging. This report presents familial colloid cysts found in a mother and daughter. Prior examples of familial colloid cysts are also reviewed and suggestions regarding the mode of inheritance and screening strategy are proposed.
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Affiliation(s)
- L A Benoiton
- Neurosurgery Department, Wellington Hospital, Capital and Coast District Health Board, Riddiford Street, Newtown, Wellington 6021, New Zealand.
| | - J Correia
- Neurosurgery Department, Starship Hospital, Auckland, New Zealand
| | - A S Kamat
- Neurosurgery Department, Wellington Hospital, Capital and Coast District Health Board, Riddiford Street, Newtown, Wellington 6021, New Zealand
| | - A Wickremesekera
- Neurosurgery Department, Wellington Hospital, Capital and Coast District Health Board, Riddiford Street, Newtown, Wellington 6021, New Zealand
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Barber SM, Rangel-Castilla L, Baskin D. Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis. Minim Invasive Surg 2013; 2013:898753. [PMID: 24191196 PMCID: PMC3804403 DOI: 10.1155/2013/898753] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/08/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a systematic review of the literature to provide a better understanding of the virtues and limitations of endoscopic tumor resection. Materials and Methods. 40 articles describing 668 endoscopic tumor resections were selected from the Pubmed database and reviewed. Results. Complete or near-complete resection was achieved in 75.0% of the patients. 9.9% of resected tumors recurred during the follow-up period, and procedure-related complications occurred in 20.8% of the procedures. Tumor size ≤ 2cm (P = 0.00146), the presence of a cystic tumor component (P < 0.0001), and the use of navigation or stereotactic tools during the procedure (P = 0.0003) were each independently associated with a greater likelihood of complete or near-complete tumor resection. Additionally, the complication rate was significantly higher for noncystic masses than for cystic ones (P < 0.0001). Discussion. Neuroendoscopic outcomes for intraventricular tumor resection are significantly better when performed on small, cystic tumors and when neural navigation or stereotaxy is used. Conclusion. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors of a particular morphology.
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Affiliation(s)
- Sean M. Barber
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
| | - Leonardo Rangel-Castilla
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
| | - David Baskin
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
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Hadjipanayis CG, Schuette AJ, Boulis N, Hao C, Barrow DL, Teo C. Full scope of options. Neurosurgery 2013; 67:197-203; discussion 203-4. [PMID: 20559107 DOI: 10.1227/01.neu.0000370602.15820.e4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of Clinical Problem Solving articles is to present management challenges to give practicing neurosurgeons insight into how field leaders address these dilemmas. This illustration is accompanied by a brief review of the literature on the topic. PRESENTATION The case of a 16-year-old boy presenting with headaches is presented. The patient is found to have a typical colloid cyst at the foramen of Monro. Bilateral ventriculoperitoneal shunt placement had been performed as an initial treatment of the patient before presentation. RESULTS Surgeons experienced in open and endoscopic surgery discuss their individual approaches to colloid cysts, in the context of previous shunting, providing a varied perspective on the clinical challenges posed by these lesions. CONCLUSION Both open and endoscopic options remain viable for excision of a colloid cyst. Each has associated potential complications, as illustrated by the current case.
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Affiliation(s)
- Costas G Hadjipanayis
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Supratentorial neurenteric cyst with spontaneous repetitive intracystic hemorrhage mimicking brain abscess: a case report. Neurosurg Rev 2013; 37:153-9. [DOI: 10.1007/s10143-013-0476-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 01/17/2013] [Accepted: 03/10/2013] [Indexed: 11/30/2022]
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Hoffman CE, Savage NJ, Souweidane MM. The Significance of Cyst Remnants After Endoscopic Colloid Cyst Resection. Neurosurgery 2013; 73:233-7; discussion 237-9. [DOI: 10.1227/01.neu.0000430300.10338.71] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Controversy surrounds the fate of cyst remnants after endoscopic colloid cyst resection.
OBJECTIVE:
Our study evaluated recurrence rates in patients with total endoscopic resection of colloid cysts vs those with coagulated cyst remnants.
METHODS:
Sixty-five consecutive patients and 67 procedures for endoscopic resection of colloid cysts from 1995 to 2011 were reviewed. Degree of resection was based on intraoperative assessment and postoperative magnetic resonance imaging (MRI). Recurrence rates were compared between patients with complete resection those with coagulated cyst remnants.
RESULTS:
Data analysis was performed of 56 patients and 58 procedures, with no follow-up in 9 patients. All patients had MRI-defined complete resection. On intraoperative assessment, 9 procedures had coagulated remnants and 45 procedures had complete resection (4 data unknown). The overall recurrence rate was 6.89% (4/58), 33.3% (3/9) with cyst remnants, and 2.2% (1/45) with total resection (P = .0124). Maximum follow-up was 144 months (mean, 40.4 months). Mean follow-up was 66.0 months for cyst remnant cases, and 33.5 months for totally resected cases. There was no mortality or permanent morbidity. Transient morbidity included memory deficit (n = 2), aseptic meningitis (n = 1), and local wound infection (n = 1).
CONCLUSION:
Endoscopic colloid cyst resection results in a low overall recurrence rate. Immediate postoperative MRI was insufficient for assessing degree of resection and was a poor predictor of recurrence. Ablation of cyst remnants rather than total removal is associated with a significantly higher rate of recurrence. The primary goal of endoscopic surgery should, therefore, be removal of all cyst contents and wall remnants.
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Affiliation(s)
- Caitlin E. Hoffman
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York
| | - Nicole J. Savage
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York
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Tamura Y, Uesugi T, Tucker A, Ukita T, Tsuji M, Miyake H, Kuroiwa T. Hemorrhagic colloid cyst with intraventricular extension. J Neurosurg 2013; 118:498-501. [DOI: 10.3171/2012.10.jns12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Colloid cysts of the third ventricle presenting with acute obstructive hydrocephalus due to intracystic and intraventricular hemorrhage are extremely rare. The authors report a case of a 43-year-old man with a hemorrhagic colloid cyst that was treated using endoscopic surgery. A small colloid cyst of the third ventricle was initially diagnosed in the patient, and he was treated conservatively at that time. On admission to the authors' institution he presented with sudden headache onset without neurological deficits. Computed tomography and MRI demonstrated a round hemorrhagic mass lesion in the third ventricle with bilateral intraventricular hemorrhage. Endoscopic resection was performed using a flexible videoscope. Only partial removal of the cyst was performed because of a tough cyst wall with highly viscous, hemorrhagic cystic contents. Histological examination revealed a typical colloid cyst wall and hemorrhage mixed within a mucinous substance. Postoperative serial neuroimaging demonstrated a gradual reduction in the residual cyst size and normalization in the lateral ventricle size.
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Affiliation(s)
- Yoji Tamura
- 1Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka; and
| | - Teppei Uesugi
- 2Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Adam Tucker
- 2Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Tohru Ukita
- 2Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Masao Tsuji
- 2Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Hiroji Miyake
- 2Department of Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Toshihiko Kuroiwa
- 1Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka; and
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Margetis K, Souweidane MM. Endoscopic Treatment of Intraventricular Cystic Tumors. World Neurosurg 2013; 79:S19.e1-11. [DOI: 10.1016/j.wneu.2012.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/02/2012] [Indexed: 10/14/2022]
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Wait SD, Gazzeri R, Wilson DA, Abla AA, Nakaji P, Teo C. Endoscopic Colloid Cyst Resection in the Absence of Ventriculomegaly. Oper Neurosurg (Hagerstown) 2013; 73:ons39-46; ons46-7. [DOI: 10.1227/neu.0b013e3182870980] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The absence of ventriculomegaly has been considered an overt or relative contraindication to the endoscopic resection of colloid cysts. In the past, endoscopic removal of colloid cysts in the absence of ventriculomegaly has been considered ill advised. Reports of successful endoscopic surgery in small ventricles are surfacing.
OBJECTIVE:
We examined the combined experience of 2 high-volume endoscopic centers to characterize the outcomes of patients undergoing endoscopic removal of colloid cysts in small ventricles.
METHODS:
We retrospectively reviewed all endoscopic colloid cyst removal procedures by the 2 senior authors (P.N., C.T.) performed at the Barrow Neurological Institute over an 8-year period. Radiographic, clinical, and interview data were recorded and analyzed. The age-adjusted relative bicaudate index was used to define small ventricles.
RESULTS:
Sixteen patients (8 female) underwent attempted endoscopic removal of a colloid cyst in the absence of ventriculomegaly. Surgery was technically successful in 15 patients. The cyst was removed completely in 13 of patients. Short-term memory loss was initially present in 3 patients and completely resolved in all but 1 patient who had presented with short-term memory loss. Temporary complications occurred in 2 patients.
CONCLUSION:
Normal-size ventricles are not a contraindication to endoscopic removal of third ventricular colloid cysts. Complication rates are at least comparable to those of patients with ventriculomegaly or to those undergoing open microsurgical resection.
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Affiliation(s)
- Scott D. Wait
- Center for Minimally Invasive Neurosurgery, Prince of Wales Hospital/University of New South Wales, Sydney, Australia
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Levine Children's Hospital, Carolinas Medical Center, Charlotte, North Carolina
| | - Roberto Gazzeri
- Center for Minimally Invasive Neurosurgery, Prince of Wales Hospital/University of New South Wales, Sydney, Australia
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - David A. Wilson
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Adib A. Abla
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Charles Teo
- Center for Minimally Invasive Neurosurgery, Prince of Wales Hospital/University of New South Wales, Sydney, Australia
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Kapu R, Symss NP, Pande A, Vasudevan MC, Ramamurthi R. Management of pediatric colloid cysts of anterior third ventricle: A review of five cases. J Pediatr Neurosci 2012; 7:90-5. [PMID: 23248682 PMCID: PMC3519091 DOI: 10.4103/1817-1745.102563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Object: Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated. Materials and Methods: Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment. Results: Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died 4 hours after the admission. On follow-up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances. Conclusion: Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared with the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
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Affiliation(s)
- Ravindranath Kapu
- Department of Neurosurgery, Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
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