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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Musa G, Simfukwe K, Gots A, Chmutin G, Chmutin E, Chaurasia B. Clinical and radiological characteristics in fatal third ventricle colloid cyst. Literature review. J Clin Neurosci 2020; 82:52-55. [PMID: 33317739 DOI: 10.1016/j.jocn.2020.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colloid cysts are a benign tumor that is almost exclusively found in the third ventricle and may cause hydrocephalus and rarely life-threatening acute deterioration and even sudden death. With very few cases of sudden death reported in literature not much is known about the patient and cyst characteristics in these patients. The authors present a review of 65 cases of colloid cyst attributed deaths in literature. MATERIALS AND METHODS A literature search for sudden death with radiologically or pathologically identified colloid cyst was done on PubMed, google scholar, Medbase and clinicaltrials.org research drives. Patient demographics, symptoms and cyst characteristics were recorded and analyzed. A Bivaret Pearson correlationcoefficientwas used to analyze and compare the relationship between each antecedent symptom, cyst size, and, cyst hemorrhage in patients who subsequently succumbed and died in order to ascertain possible relation. RESULTS Most patients had a history of sudden severe headaches (p = 0.01) with associated vomiting (p = 0.03). Radiologically, cyst associated ventriculomegaly was seen in 97% (P = 0.78) was a notable feature. Even more, the cyst size (p = 0.01) and associated hemorrhage (p = 0.02) were also major notable feature preceding sudden death in both gender group. CONCLUSION Acute deterioration in colloid cysts is rare, but can be fatal. Associated symptoms include severe headache and vomiting. Seizures are commonly seen in patients in the first two decades. Given the risk of acute deterioration and mortality, headaches should be thoroughly investigated and all patients diagnosed with a colloid cyst > 1 cm should be offered surgical management regardless of symptom profile.
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Affiliation(s)
- Gerald Musa
- Neurosurgery Resident, Peoples Friendship University of Russia, Russia.
| | - Keith Simfukwe
- Neurosurgery Resident, Peoples Friendship University of Russia, Russia
| | | | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kutty RK, Balakrishnan Sreemathyamma S, Sivanandapanicker JL, Asher P, Peethambaran A, Nair NG. Spontaneous Change in Density of Colloid Cyst: An Unusual Phenomenon. World Neurosurg 2020; 141:226-231. [PMID: 32461180 DOI: 10.1016/j.wneu.2020.05.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Colloid cysts of the third ventricle are benign congenital lesions. They are at times totally asymptomatic or may be detected in the evaluation for headache, neurologic disturbances, or psychiatric disturbances. They may sometimes cause grave consequences such as coma or even sudden death. The radiologic appearance is unique and important for making decisions in the management. CASE DESCRIPTION We report a patient with a colloid cyst who presented to us after sudden deterioration in consciouness. It was noted that he underwent brain computed tomography (CT) scan 10 months ago in the evaluation of headache. Compared with previous CT scan, there was a sudden change in the density and size of the colloid cyst with obstructive hydrocephalus. This unique change in the character of the colloid cyst occurred without any intervention. We discuss the possible etiologies behind this phenomenon along with a review of the literature. CONCLUSIONS This case stands out remarkably because it is only the second case in literature with similar natural history.
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Affiliation(s)
- Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India.
| | | | | | - Prasanth Asher
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Singh H, Burhan Janjua M, Ahmed M, Esquenazi Y, Dhandapani S, Mauer E, Schwartz TH, Souweidane MS. 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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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Al-Sharydah AM, Al-Suhibani SS, Al-Abdulwahhab AH, Al-Aftan MS, Gashgari AF. A unique finding of cavum velum interpositum colloid-like cyst and literature review of a commonplace lesion in an uncommon place. Int J Gen Med 2018; 11:301-305. [PMID: 30038515 PMCID: PMC6052918 DOI: 10.2147/ijgm.s169018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Colloid cysts typically reside within the area of the anterior third ventricle, in the proximity of the foramen of Monro. Although they are considered to commonly localize in various parts of the cerebrum, they are exceedingly rare outside the ventricular system and rarely occur within the velum interpositum. We have reported here a rare case of a velum interpositum colloid-like cyst in a 23-year-old man, who presented to our clinic with temporary binocular strabismus, which he had been experiencing for the previous year. In addition, we have briefly reviewed evidence regarding the generation, anatomy, and pathogenesis of colloid cysts, as well as the management options for such rare cases. The present report is only the third to describe a colloid-like cyst located within the velum interpositum, providing additional data that may aid in elucidating the pathogenesis of these neoplasms.
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Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Sari Saleh Al-Suhibani
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Mohammad Saad Al-Aftan
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Ahmad Fouad Gashgari
- Diagnostic Radiology Department, Dammam Central Hospital, Dammam, Eastern Province, Saudi Arabia
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9
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Kleinschmidt-DeMasters BK, Lillehei KO, Hankinson TC. Review of xanthomatous lesions of the sella. Brain Pathol 2017; 27:377-395. [PMID: 28236350 DOI: 10.1111/bpa.12498] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/28/2022] Open
Abstract
Xanthomatous lesions of the sellar region have traditionally been divided into two separate categories, xanthomatous hypophysitis (XH) and xanthogranuloma (XG) of the sellar region. The seminal article on XH, a condition typified by foamy histiocytes and lymphoplasmacytic infiltrates in the pituitary gland/sellar region, but usually little or no hemosiderin pigment, detailed three patients. However, most reports since that time have been single cases, making understanding of the entity difficult. In contrast, the seminal report on XG, characterized by sellar region cholesterol clefts, lymphoplasmacytic infiltrates, marked hemosiderin deposits, fibrosis, multinucleated giant cells around cholesterol clefts, eosinophilic granular necrotic debris, and accumulation of macrophages, included 37 patients, allowing more insights into etiology. Few examples could be linked to adamantinomatous craniopharyngioma, and although ciliated epithelium similar to that of Rathke cleft cyst (RCC) was identified up to 35% of the 37 cases, it could not be proven that XG was related to hemorrhage into RCC. Case reports since that time, however, occasionally linked XG to RCC when an etiology could be identified at all, and a few recognized that a spectrum exists in xanthomatous lesions of the sella. They review literature, adding 23 cases from our own experience, to confirm that overlap occurs between XH and XG, and that the majority-but not all-can be linked to RCC leakage/rupture/hemorrhage. It was suggested that progressive accumulation of hemosiderin pigment in the lesion, possibly caused by the multiple episodes of bleeding, could account for the transition of at least some cases of XH to XG.
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Affiliation(s)
- B K Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO.,Morgan Adams Foundation Pediatric Brian Tumor Research Program
| | - Todd C Hankinson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO
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Akhavan R, Zandi B, Pezeshki-Rad M, Farrokh D, Abbasi B. Hemorrhagic Colloid Cyst Presenting with Acute Hydrocephaly. Case Rep Neurol Med 2017; 2017:2978080. [PMID: 28210514 DOI: 10.1155/2017/2978080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022] Open
Abstract
Colloid cysts are benign slow-growing cystic lesions located on the roof of the third ventricle that usually present with symptoms related to gradual rise of intracranial pressure. They mostly remain asymptomatic and sometimes grow progressively and cause diverse symptoms associated with increased intracranial pressure such as headache, diplopia, and sixth cranial nerve palsy. Here we report a 47-year-old female who presented to the emergency department with acute severe headache and nausea/vomiting. On MRI examination acute hydrocephaly due to hemorrhagic colloid cyst was detected. Acute hemorrhage in colloid cysts is extremely rare and may present with symptoms of acute increase in the intracranial pressure. Intracystic hemorrhage is very rarely reported as a complication of colloid cyst presenting with paroxysmal symptoms of acute hydrocephaly.
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Hamidi H, Faizi FR, Rasouly N, Hoshang MMS. CT and MRI Features of Pediatric-Aged Colloid Cysts: Report of Two Cases. Case Rep Radiol 2017; 2017:1-4. [PMID: 28255492 PMCID: PMC5306994 DOI: 10.1155/2017/2467085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/18/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
A 10-year-old boy with the history of headache, anorexia, and vomiting was referred to our department to undergo a brain CT scan. CT images demonstrated a well-defined, rounded, hyperdense lesion at the level of the foramen of Monro causing moderate dilatation of the lateral ventricles. An 11-year-old girl with a long history of a headache was also referred to undergoing a brain MRI. MR images demonstrated a well-defined round abnormal signal intensity lesion at the level of the foramen of Monro causing moderate dilatation of lateral ventricles. The findings from imaging perspective were consistent with the colloid cyst of the third ventricle. Therefore, the diagnosis of the colloid cyst was made.
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Sharifi G, Rahmanzadeh R, Lotfinia M, Rahmanzade R. Pilocytic Astrocytoma of Fornix Mimicking a Colloid Cyst: Report of 2 Cases and Review of the Literature. World Neurosurg 2016; 109:31-35. [PMID: 28024978 DOI: 10.1016/j.wneu.2016.12.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colloid cyst is a gelatin-containing cyst in the brain almost always found in the third ventricle. The specific shape and location of these cysts, a round well-delineated mass in the rostral part of the third ventricle adjacent to the foramen of Monro, on imaging are the main findings for diagnosis. Several masses of the third ventricle masquerading colloid cysts on images have been reported. Based on different surgical approaches, preoperative misdiagnosis of colloid cyst may have great impact on prognosis. METHODS We report 2 cases that presented with severe headache and hydrocephalus, and their preoperative images were highly indicative of colloid cyst. RESULTS Histopathologic investigations after tumor resection showed pilocytic astrocytoma of fornix in both cases. CONCLUSIONS Fifteen cases of colloid cyst misdiagnosis with other masses have been reported thus far; among them, 2 cases were pilocytic astrocytoma. In this study we report 2 other cases. Furthermore, we discuss additional clues helping to differentiate pilocytic astrocytoma from colloid cyst on images.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rahmanzadeh
- Neuroscience Division, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Lotfinia
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Rahmanzade
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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13
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Abstract
OBJECTIVE
Mineralized or desiccated colloid cysts pose some unique challenges to endoscopic removal. The extrusion of the solid matrix into the intraventricular compartment has not been previously reported and, as such, no guidance exists regarding its predilection, prevention, and fate.
METHODS
Postoperative imaging studies in a registry of patients undergoing endoscopic removal of colloid cyst were reviewed to detect any solid matrix within the ventricular compartment. Preoperative images and operative notes were used to determine if any features were predictive. Serial postoperative images and clinical notes were used to characterize the implications of these findings.
RESULTS
From a review of 94 patients, 10 (10.6%) patients had evidence of an extruded intraventricular solid fragment (median follow-up 4 months; range 0.5–115 months). Of the evaluable patients, 7 of 9 patients had T1-weighted hyperintense and T2-weighted hypointense cysts on preoperative scans. Seventy-eight percent of the extrusions were on the same side as the endoscopic entry. Three patients demonstrated early fragment migration, but not after 8 months of radiological follow-up. All evaluable patients demonstrated improvement in their hydrocephalus, and none suffered a complication attributable to the intraventricular extruded fragments.
CONCLUSIONS
Intraventricular extruded colloid fragments can occur after endoscopic resection, with the possible risk demonstrated as cyst hypointensity on preoperative T2-weighted images. The finding does not seem to result in any clinical morbidity, and radiographic involution is the rule. Migratory capacity, however, does exist and justifies a more frequent imaging surveillance schedule and consideration for removal.
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Affiliation(s)
- Assem M. Abdel Latif
- 1Department of Neurological Surgery, Ain Shams University, Cairo, Egypt
- 2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Medical College, Cornell University, New York; and
| | - Mark M. Souweidane
- 2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Medical College, Cornell University, New York; and
- 3Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Byard RW. Variable Presentations of Lethal Colloid Cysts. J Forensic Sci 2016; 61:1538-1540. [DOI: 10.1111/1556-4029.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/22/2015] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Roger W. Byard
- School of Medicine; The University of Adelaide; Frome Rd Adelaide SA 5005 Australia
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15
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Zabihyan S, Etemadrezaie H, Baharvahdat H, Baradaran A, Ganjeefar B, Bohl MA, Nakaji P. Remote transplantation of a third ventricle colloid cyst: case report. J Neurosurg 2015; 122:1406-10. [DOI: 10.3171/2014.9.jns14864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a 15-year-old girl with a third ventricle colloid cyst. She presented with prolonged headache, nausea, vomiting, and loss of visual acuity with bilateral papilledema. Computed tomography and MRI revealed severe biventricular hydrocephalus with transependymal periventricular fluid and a minimally enhancing cystic mass of the third ventricle. The patient was diagnosed with a colloid cyst and obstructive hydrocephalus, and endoscopic resection with ablation of the cyst remnant was performed. While attempting to extricate the cyst from the patient's head, control of the cyst was lost and the cyst fell into the lateral ventricle beyond the surgeon's view. Postoperative imaging showed that the cyst had settled in the right occipital horn. After 3 years of follow-up, imaging suggests growth of the cyst in its new position without necrosis or displacement on prone imaging.
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Affiliation(s)
- Samira Zabihyan
- 1Department of Neurological Surgery, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Hamid Etemadrezaie
- 1Department of Neurological Surgery, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Humain Baharvahdat
- 1Department of Neurological Surgery, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Aslan Baradaran
- 1Department of Neurological Surgery, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Babak Ganjeefar
- 1Department of Neurological Surgery, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Michael A. Bohl
- 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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16
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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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Kitamura Y, Sasaki H, Hashiguchi A, Momoshima S, Shidoh S, Yoshida K. Supratentorial neurenteric cyst with spontaneous repetitive intracystic hemorrhage mimicking brain abscess: a case report. Neurosurg Rev 2014; 37:153-9. [DOI: 10.1007/s10143-013-0476-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [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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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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Carrasco R, Pascual JM, Medina-López D, Burdaspal-Moratilla A. Acute hemorrhage in a colloid cyst of the third ventricle: A rare cause of sudden deterioration. Surg Neurol Int 2012; 3:24. [PMID: 22439115 PMCID: PMC3307247 DOI: 10.4103/2152-7806.92932] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/24/2012] [Indexed: 12/04/2022] Open
Abstract
Background: Acute neurological deterioration and death in a patient harboring a colloid cyst of the third ventricle remains a poorly understood phenomenon. Sudden neurological derangement caused by spontaneous bleeding within a colloid cyst is a rare and potentially fatal event, usually requiring immediate diagnosis and emergency surgical treatment. Case Description: A 47-year-old male presented with acute right-sided hemiparesis and speech impediment, followed by rapid deterioration of consciousness. Neuroimaging studies showed a rounded mass at the roof of the anterior third ventricle, causing biventricular hydrocephalus along with a left-sided basal ganglia hematoma. The lesion showed scattered foci of a recent hemorrhage which extended into the left lateral ventricle. Surgical treatment involved emergency external ventricular drainage followed by the prompt elective total resection of the lesion via a transcallosal route. Pathological findings confirmed the diagnosis of a colloid cyst with focal areas of vascular congestion and blood extravasation within its wall. Conclusions: Spontaneous bleeding into a colloid cyst of the third ventricle may cause acute obstructive hydrocephalus and intracranial hypertension due to rapid enlargement of the lesion. This event may account for the sudden neurological deterioration and/or death observed in a previously asymptomatic patient. The diagnosis of hemorrhagic phenomena within a colloid cyst represents a challenge due to the variable signal usually displayed by these lesions on computed tomography (CT) and magnetic resonance imaging (MRI). Emergency ventricular drainage followed by elective tumoral removal constitutes a valid and safe treatment strategy.
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Affiliation(s)
- Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
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20
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Silva D, Matis G, Chrysou O, Carvalho Junior EVD, Costa L, Kitamura M, Birbilis T, Azevedo Filho H. Sudden death in a patient with a third ventricle colloid cyst. Arq Neuro-Psiquiatr 2012; 70:311. [DOI: 10.1590/s0004-282x2012005000005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Danilo Silva
- Weill Cornell Medical College, USA; Restauração Hospital, Brazil
| | | | - Olga Chrysou
- Democritus University of Thrace Medical School, Greece
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21
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Boogaarts HD, Decq P, Grotenhuis JA, Le Guérinel C, Nseir R, Jarraya B, Djindjian M, Beems T. Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases. Neurosurgery 2011; 68:179-87. [PMID: 21150763 DOI: 10.1227/neu.0b013e3181ffae71] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The endoscopic removal of third ventricular colloid cysts has been developed as an alternative to microsurgical transcortical-transventricular and transcallosal approaches. OBJECTIVE To examine the value of endoscopic technique by reviewing the large number of endoscopically treated patients with long-term follow-up in 2 neurosurgical centers. METHODS A retrospective chart review was conducted for all patients admitted for resection of a third ventricular colloid cyst to the Radboud University Nijmegen Medical Centre (Nijmegen, The Netherlands) and the Hôpital Henri Mondor (Paris, France) between 1994 and 2007. Both clinical and radiological symptoms and operative results were evaluated. RESULTS Postdischarge clinical follow-up was available for 85 patients over a mean period of 4 years 3 months. Permanent morbidity occurred in 1 patient (persisting preoperative memory deficit). Follow-up imaging of 80 evaluable patients showed that total or nearly total cyst removal was possible in 46 individuals (57.5%). Residual cyst was present in 34 patients (42.5%), and 6 required repeated endoscopic surgery for symptomatic regrowth. Recurrent cysts were mainly seen within the first 2 years after surgery. CONCLUSION It is debatable whether the higher numbers of recurrent or residual cysts can be justified by the slightly lower complication rates achieved with endoscopic removal. However, results have been improving over the years. Moreover, the modifications observed on control magnetic resonance images justify the need for regular control imaging for at least the first 2 years postoperatively.
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Affiliation(s)
- Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Demirci S, Dogan KH, Erkol Z, Gulmen MK. Sudden death due to a colloid cyst of the third ventricle: Report of three cases with a special sign at autopsy. Forensic Sci Int 2009; 189:e33-6. [DOI: 10.1016/j.forsciint.2009.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 04/02/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
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Hingwala DR, Sanghvi DA, Shenoy AS, Dange NN, Goel AH. Colloid cyst of the velum interpositum: a common lesion at an uncommon site. ACTA ACUST UNITED AC 2009; 72:182-4. [DOI: 10.1016/j.surneu.2008.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 03/01/2008] [Indexed: 11/25/2022]
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Abstract
Colloid cysts of the third ventricle are benign intracranial tumors that usually become symptomatic in adults, rather than in children. Rare hemorrhages in these cysts can cause acute obstructive hydrocephalus and sudden death. We report a novel pediatric case of hemorrhagic colloid cyst in a 9-year-old girl who presented with headaches, nausea, and had sudden deterioration of her mental status. The patient underwent emergent ventriculostomy and then craniotomy to resect the colloid cyst; she had an excellent recovery.
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Affiliation(s)
- Muhammad U Farooq
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA.
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