RSS-Feed abonnieren
DOI: 10.1055/s-2006-950385
© Georg Thieme Verlag KG · Stuttgart · New York
Endoscopic Approach to Colloid Cysts
Publikationsverlauf
Publikationsdatum:
12. Dezember 2006 (online)
![](https://www.thieme-connect.de/media/min/200605/lookinside/thumbnails/10.1055-s-2006-950385-1.jpg)
Abstract
Objective: The aim of this study is to discuss the variations in the morbid anatomy of colloid cysts with its impact on the choice of endoscopic approach through a standard Kocher's burr hole. Methods: This study was conducted on 18 patients between 1996 and 2006. All patients were operated through a single burr hole at Kocher's point using a rigid endoscope with a single working channel. The anatomical variations of the cyst and the foramen of Monro dictated the use of the transforaminal approach, the transseptal interforniceal approach or both. Results: There were no mortalities or significant morbidities. The operative time ranged between 90 to 240 minutes (with a mean of 133 minutes). Five patients (27.7%) developed remediable postoperative chemical meningitis successfully controlled with steroids. Postoperative transient memory disturbance was observed in 3 patients (16.7%). One patient had a postoperative CSF leak that stopped spontaneously. Aspiration of the cyst's contents showed variable degrees of resistance to aspiration. The period of follow-up ranged between 5 months to 8 years and 3 months (mean: 4 years and 2 months). None of our patients showed radiological evidence of cyst recurrence during the follow-up period. Conclusion: Through a single right pre-coronal burr hole at Kocher's point, several endoscopic manoeuvres can be done. These include aspiration of the contents or its piecemeal removal, combined balloon squeeze and aspiration, foraminoplasty, pellucidotomy, coagulation of cyst capsule and ETV. The choice of the appropriate approach is largely dependent on the location of the cyst and the shape of the foramen of Monro. Coronal MRI may aid in preoperative evaluation of the tucked up retroforaminal growth of the cyst. We had no recurrence in our series with a follow-up reaching more than 8 years. This could be attributed to both the marsupialization and coagulation done for the remaining cyst capsule.
Key words
Neuroendoscopy - colloid cysts - transforaminal approach - transseptal interforniceal approach
References
- 1 Abernathey CD, Davis DH, Kelly PJ. Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy. J Neurosurg. 1989; 70 525-529
- 2 Campbell JR, Withfield R. Benign intraventricular tumors of the brain. NYSJ Med. 1940; 40 733-740
- 3 Little JR, MacCarty CS. Colloid cysts of the third ventricle. J Neurosurg. 1974; 40 230-235
- 4 Dandy WE. Benign tumors of the third ventricle: diagnosis and treatment. Springfield, IL., Charles C. Thomas 1933 pp 1-37
- 5 Gutierrez-Lara F, Patino R, Hakim S. Treatment of tumors of the third ventricle: A new and simple technique. Surg Neurol. 1975; 3 323-325
- 6 Abernathey CD, Davis DH, Kelly PJ. Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy. J Neurosurg. 1989; 70 525-529
- 7 Desai SR, Sidhu PS, Dawson JM. An unusual consequence of stereotactic colloid cyst aspiration: Case report. Australas Radiol. 1997; 41 377-379
- 8 Hellwig D, Bauer BL, List-Hellwig E. Stereotactic interventions in cystic brain lesions. Acta Neurochir Suppl (Wien). 1995; 64 59-63
- 9 Antunes JL, Louis KM, Ganti SR. Colloid cysts of the third ventricle. Neurosurgery. 1980; 7 450-455
- 10 Apuzzo MLJ, Chikovani OK, Gott PS, Teng EL, Zee CS, Giannotta SL, Weiss MH. Transcallosal, interfornicial approaches for lesions affecting the third ventricle: Surgical considerations and consequences. Neurosurgery. 1982; 10 547-554
- 11 Mathiesen T, Grane P, Lindgren L, Lindquist C. Third ventricle colloid cysts: A consecutive 12-year series. J Neurosurg. 1997; 86 5-12
- 12 Desai KI, Nadkarni TD, Muzumdar DP, Goel AH. Surgical management of colloid cyst of the third ventricle a study of 105 cases. Surg Neurol. 2002; 57 295-302
- 13 Chen TC, Krieger M, Hinton DR, Zee CS, Apuzzo LJ. The colloid cyst. In: Apuzzo MLJ (ed), Surgery of the Third Ventricle, 2nd edn. Philadelphia, Lippincott Williams & Wilkins 1997 pp 1071-1131
- 14 Hellwig D, Bauer BL, Schulte M, Gatscher S, Riegel T, Bertalanffy H. Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery. 2003; 52 525-533
- 15 Abdou MS, Cohen AR. Endoscopic treatment of colloid cysts of the third ventricle: Technical note and review of the literature. J Neurosurg. 1998; 89 1062-1068
- 16 Auer LM, Holzer P, Ascher PW, Heppner F. Endoscopic neurosurgery. Acta Neurochir (Wien). 1988; 90 1-14
- 17 Bauer BL, Hellwig D. Minimally invasive endoscopic neurosurgery: A survey. Acta Neurochir Suppl (Wien). 1994; 61 1-12
- 18 Caemaert J, Abdullah J, Calliauw L. Endoscopic diagnosis and treatment of para- and intraventricular cystic lesions. Acta Neurochir Suppl (Wien). 1994; 61 69-75
- 19 Decq P, Le Guerinel C, Brugieres P, Djindjian M, Silva D, Keravel Y, Melon E, Nguyen JP. Endoscopic management of colloid cysts. Neurosurgery. 1998; 42 1288-1296
- 20 Deinsberger W, Böker DK, Bothe HW, Samii M. Stereotactic endoscopic treatment of colloid cysts of the third ventricle. Acta Neurochir (Wien). 1994; 131 260-264
- 21 Deinsberger W, Böker DK, Samii M. Flexible endoscopes in treatment of colloid cysts of the third ventricle. Minim Invas Neurosurg. 1994; 37 12-16
- 22 Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D. Neuroendoscopic surgery of intracranial cysts in adults. Childs Nerv Syst. 2004; 20 842-851
- 23 Kehler U, Brunori A, Gliemroth J, Nowak G, Delitala A, Chiappetta F, Arnold H. Twenty colloid cysts: Comparison of endoscopic and microsurgical management. Minim Invas Neurosurg. 2001; 44 121-127
- 24 King WA, Ullman JS, Frazee JG, Post KD, Bergsneider M. Endoscopic resection of colloid cysts: Surgical considerations using the rigid endoscope. Neurosurgery. 1999; 44 1103-1111
- 25 Rodziewicz GS, Smith MV, Hodge Jr CJ. Endoscopic colloid cyst surgery. Neurosurgery. 2000; 46 655-662
- 26 Schroeder HW, Gaab MR. Endoscopic resection of colloid cysts. Neurosurgery. 2002; 51 1441-1444
- 27 Powell MP, Torrens MJ, Thomson JL, Hogan JG. Isodense colloid cysts of the third ventricle: A diagnostic and therapeutic problem resolved by ventriculoscopy. Neurosurgery. 1983; 13 234-237
- 28 Macaulay RJB, Felix I, Jay V, Becker LE. Histological and ultrastructural analysis of six colloid cysts in children. Acta Neuropathol. 1997; 93 271-276
- 29 Vialogo JG. Endoscopic transepto-interforniceal approach to colloid cysts: case report. Arq Neuropsiquiatr. 2000; 58 ((3B)) 939-946
-
30 Apuzzo MLJ, Amar AP. Transcallosal interforniceal approach. In: Apuzzo MLJ (ed)
Surgery of the Third Ventricle, 2nd edn. Williams and Wilkins, Baltimore 1998 pp 421-452
Correspondence
Prof. Ahmed Zohdi
Cairo Medical Tower
55 Abdel Monem Riad St.
El Mohandeseen Giza
Postal code 12411
Cairo
Egypt
Telefon: +20/12/210 33 20
Fax: +20/2/363 43 93
eMail: azohdi54@yahoo.com