Minim Invasive Neurosurg 2001; 44(3): 121-127
DOI: 10.1055/s-2001-18122
ORIGINAL PAPER
Georg Thieme Verlag Stuttgart · New York

Twenty Colloid Cysts - Comparison of Endoscopic and Microsurgical Management

U. Kehler1 , A. Brunori2 , J. Gliemroth1 , G. Nowak1 , A. Delitala2 , F. Chiappetta2 , H. Arnold1
  • 1Department of Neurosurgery, Medical University of Lübeck, Lübeck, Germany
  • 2Department of Neurosciences “G. M. Lancisi”, Division of Neurosurgery, San Camillo Hospital, Rome, Italy
Further Information

Publication History

Publication Date:
31 October 2001 (online)

The management of colloid cyst remains controversial, evaluation of the competing methods seems to be necessary. We report on our experience with colloid cysts in the last decade: ten were managed solely endoscopically, 10 were resected microsurgically (9 via a transcortical/transventricular, 1 via a transcallosal approach). The outcome in the endoscopic group was excellent in 9 cases and unsatisfying in 1 case (recurrence). In the microsurgical group we achieved a good outcome in 5 of 10 cases, a fair outcome in 4 cases and 1 lethal outcome (caused by pulmonary embolism). Complications in the endoscopic group: one intraoperative bleeding, 1 stitch granuloma, 1 mispuncture of the ventricle, and 1 meningitis. Complications in the microsurgical group: 1 subdural effusion, 1 flap infection, 1 mild hemiparesis, 1 transient impairment of consciousness and 1 pulmonary embolism.

Mean operative time and length of hospitalization of the endoscopic group were clearly shorter than in the microsurgical group: 91 min versus 267 min time of surgery, 5.1 days versus 18.9 days of hospitalization. Complete resection was achieved in 8 of 10 cases of microsurgery, and in 3 of 10 cases in endoscopy. Endoscopic management results in lower costs and superior patients' comfort. The reduced number of total resections in the endoscopic group may lead to a higher recurrence rate in long-term follow-up, which might be a serious disadvantage of endoscopy. However, more experience in the endoscopic techniques may result in a higher rate of total resection of colloid cysts.

References

  • 1 Fritsch H. Colloid cysts - a review including 19 own cases.  Neurosurg Rev. 1988;  11 159-166
  • 2 Hernesniemi J, Leivo S. Management outcome in third ventricular colloid cysts in a defined population. A series of 40 patients treated mainly by transcallosal microsurgery.  Surg Neurol. 1996;  45 2-14
  • 3 Hall W A, Lunsford L D. Changing concepts in the treatment of colloid cysts. An 11-year experience in the CT era.  J Neurosurg. 1987;  66 186-191
  • 4 Kondziolka D, Lunsford L D. Aspiration of colloid cysts.  Neurosurg. 1993;  79 965-966
  • 5 Lewis A I, Crone K R, Taha J, van Loveren H R, Yeh H S, Tew Jr J M. Surgical resection of third ventricle colloid cysts. Preliminary results comparing transcallosal microsurgery with endoscopy.  J Neurosurg. 1994;  81 174-178
  • 6 Macdonald R L, Humphreys R P, Rutka J T, Kestle J RW. Colloid cysts in children.  Pediatr Neurosurg. 1994;  20 169-177
  • 7 Mathiesen T, Grane P, Lindgren L, Lindquist L. Third ventricle colloid cysts: a consecutive 12-year series.  J Neurosurg. 1997;  86 5-12
  • 8 Caemaert J, Abdullah J. Endoscopic management of colloid cysts.  Techniques in Neurosurg. 1996;  1 185-200
  • 9 Byard R W, Moore L. Sudden and unexpected death in childhood due to a colloid cyst of the third ventricle.  J Forensic Sci. 1993;  38 210-213
  • 10 Camacho A, Abernathey C D, Kelly P J, Laws Jr E R. Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography.  Neurosurgery. 1989;  24 693-700
  • 11 Shemie S, Jay V, Rutka J, Armstrong D. Acute obstructive hydrocephalus and sudden death in children.  Ann Emerg Med. 1997;  29 524-528
  • 12 Mathiesen T, Grane P, Lindquist L, v Holst H. High recurrence rate following aspiration of colloid cysts in the third ventricle.  J Neurosurg. 1993;  78 748-752
  • 13 Abernathy C D, Davis D H, Kelly P J. Treatment of colloid cysts of the third ventricle by stereotactic microsurgical laser craniotomy.  J Neurosurg. 1989;  70 525-529
  • 14 Cabell K L, Ross D A. Stereotactic Microsurgical craniotomy for the treatment of third ventricular colloid cysts.  Neurosurg. 1996;  38/2 301-307
  • 15 Cetinalp E, Ildan F, Boyar B, Bagdatoglu H, Uzuneyupoglu Z, Karadayi A. Colloid cysts of the third ventricle.  Neurosurg Rev. 1994;  17 135-139
  • 16 Deinsberger W, Böker D K, Samii M. Flexible endoscopes in treatment of colloid cysts of the third ventricle.  Minim Invasive Neurosurg. 1994;  37 12-16
  • 17 Decq P, Le Guerinel C, Brugières P, Djindjian M, Silva D, Kéravel Y, Melon E, Nguyen J P. Endoscopic management of colloid cysts.  Neurosurg. 1998;  42 1288-1296
  • 18 Gökalp H Z, Yuceer N, Arasil E, Erdogan A, Dincer C, Baskaya M. Colloid cysts of the third ventricle. Evaluation of 28 cases of colloid cyst of the third ventricle operated on by transcortical transventricular (25 cases) and transcallosal/transventricular (3 cases) approaches.  Acta Neurochir. 1996;  138 45-49
  • 19 Kondziolka D, Lunsford L D. Microsurgical resection of colloid cysts using a stereotactic transventricular approach.  Surg Neurol. 1996;  46 485-490
  • 20 Yasargil M G. Colloid Cysts. In: Yasargil MG (ed.). Microneurosurgery of CNS Tumors Stuttgart-New York, Thieme Verlag 1996: 324-325
  • 21 Kondziolka D, Lunsford L D. Stereotactic techniques for colloid cysts: roles of aspiration, endoscopy, and microsurgery.  Acta Neurochir Suppl. 1994;  61 76-78
  • 22 Findlay J M. Colloid cyst removal (Letter).  J Neurosurg. 1995;  82 703-704
  • 23 Desai S R, Sidhu P S, Dawson J M. An unusual consequence of stereotactic colloid cyst aspiration: case report.  Australas Radiol. 1997;  41 377-379

Corresponding Author

U. Kehler,M.D. 

Department of Neurosurgery
University Hospital Eppendorf

Martinistraße 52

20246 Hamburg
Germany

Phone: +49-040-428032751

Email: kehler@uke.uni-hamburg.de

    >