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doxycycline Home > Archives > Volume 18, No 1 (2020) > Article

DOI: 10.14704/nq.2020.18.1.NQ20101

Collod Cyst; Endoscopic Versus Transcallusal Approach

Dr. Raad Ahmed Hussein, Dr. Muhammed Hameed Faeadh Al-Jumaily, Dr. Ahmed Adnan Abdulhameed, Dr. Injam Ibrahim Sulaiman

Abstract

BACKGROUND: Colloid cyst is a rare congenital benign intracranial neoplasm, presented between 20 & 50 years of age. Open microscopic surgery is the standard approach, but the endoscopic approach is valuable alternative & astereotactic cyst aspiration is also tried nowadays. OBJECTS: a retrospective comparative study for removal of colloid cyst of the third ventricle was made to compare between endoscopic trans-cortical & microscopictranscallosal approaches. MATERIALS & METHODS: Between 2008 & 2015, a 23 patients with colloid cyst of the 3rd ventricle were operated, the operations were 13 transcallosal craniotomy& 10 endoscopic procedure, the age of the patients varies from 9 to 63 years, there were 9 females & 14 males. The presentations were headache, nausea & vomiting, blurring of vision & gait disturbances. RESULTS: In the 13 transcallosal patients, total excision is achieved in all of them, while in the 10 endoscopic procedure, only 2 total resection can be achieved & 6 cysts evacuated with coagulation of the wall, while in 2 viscous cysts, partial resection is achieved. All the colloid cysts were located in the roof of the third ventricle near the foramen of Monroe, except 2 cases, one in the posterior third ventricle & one in the lateral ventricle, both of them treated endoscopically. In the transcallosal group, 2patients complicated postoperatively by severe memory loss in both patients, large cavum septumpellucidum was entered after callosotomy. Another One patient developed postoperative seizure. For the endoscopic group, in one case the cyst was located in the posterior 3rd ventricle, hydrocephalus persisted despite endoscopic third ventriculostomyprior to cyst resection. CONCLUSION: Transcallosal approach is a standard approach for thetreatment of colloid cyst of the 3rd ventricle. It is preferred in non dilated ventricles & in thick viscous hyperdense colloid cysts. In patients who are to be operated through transcallosal approach, the small subarachnoid space with inter digitation of cingulated gyri on coronal brain MRI indicate difficult separation of these gyri, in such a case, an extreme anterior approach should be performed & the dissection of the gyri is proceeded backward from inside to out side. Acavum septum pellucidum with the colloid cyst can lead to a forniceal body damage when the transcallosal approach is chosen, therefore endoscopic or microscopictrans-cortical approaches may have a better outcome. Large head of caudate nucleus create a technical difficulty in advancing the endoscopic sheath, a smaller sheath should be used or transchoriodal approach should be planned initially. Symptomatic colloid cyst with slit lateral ventricles is approached through transcallosal approach.

Keywords

Collod Cyst; Endoscopic Versus Transcallusal Approach

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