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Minim Invasive Neurosurg 2006; 49(5): 263-268
DOI: 10.1055/s-2006-950385
Original Article

© Georg Thieme Verlag KG · Stuttgart · New York

Endoscopic Approach to Colloid Cysts

A. Zohdi 1 , S. El. Kheshin 2
  • 1Department of Neurosurgery, Kasr El Aini School of Medicine, Cairo University, Egypt
  • 2Department of Neurosurgery, Tanta School of Medicine, Tanta University, Egypt
Further Information

Publication History

Publication Date:
12 December 2006 (online)

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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

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Correspondence

Prof. Ahmed Zohdi

Cairo Medical Tower

55 Abdel Monem Riad St.

El Mohandeseen Giza

Postal code 12411

Cairo

Egypt

Phone: +20/12/210 33 20

Fax: +20/2/363 43 93

Email: azohdi54@yahoo.com

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