Elsevier

Surgical Neurology

Volume 57, Issue 5, May 2002, Pages 295-302
Surgical Neurology

Neoplasm
Surgical management of colloid cyst of the third ventricle—a study of 105 cases

https://doi.org/10.1016/S0090-3019(02)00701-2Get rights and content

Abstract

BACKGROUND

Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised.

METHOD

A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up.

RESULTS

The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally.

Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised.

CONCLUSIONS

Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.

Section snippets

Material and method

We analyzed 105 cases of third ventricle colloid cyst managed in our department between 1967 and 1998. The clinical records, radiological findings, and operative and follow-up notes were studied retrospectively.

In the pre-CT scan era, pneumoventriculograms, ventriculograms, and angiograms were done. After 1982, CT or MRI were performed in all patients. Based on the maximum diameter as measured on the CT or MRI scans, the colloid cysts were divided into three categories—small (<1.5 cm), medium

Clinical features

The male to female ratio was 1.5:1. The age ranged from 10 to 68 years with 64.8% of patients in the third and fourth decades (Table 2). The duration of clinical complaints at the time of presentation varied from 1 week to 4 years with an average of 8 months. Headache was the most prominent clinical symptom, occurring in 92.3% of patients. It was generalized, intermittent, and was often accompanied by blurred vision and vomiting. Variation in the intensity of headaches with change of posture

Discussion

Colloid cysts have provoked interest in neurosurgeons because of their controversial origin, benign histology, often dramatic clinical presentation, and the variety of possible treatment options 21, 53, 76, 89. Mathiesen et al [61] and Nitta and Symon [67] documented male sex predominance, as noted in our series. Camacho et al found no sex difference in their large series from Mayo Clinic [16]. There was no specific age group predominance in any of these series; however, in our series 64.7% of

Conclusions

Our experience has led us to the conclusion that the transcallosal route can be used safely to excise third ventricular colloid cysts. There are no permanent deficits in memory or intellectual function because of the limited callostomy and forniceal handling. Patients harboring large cysts and presenting in a comatose state carry a poor prognosis and high mortality rate. Ventriculoperitoneal shunts are not necessary for the management of the hydrocephalus. The hydrocephalus resolves completely

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