Third ventricle colloid cysts: a consecutive 12-year series.
A continuous follow-up review of colloid cysts including aspects of natural history and evaluation of treatment options is necessary to optimize individual treatment. Thirty-seven consecutive patients with colloid cyst of the third ventricle seen at Karolinska Hospital between 1984 and 1995 were reviewed. Five patients were admitted in a comatose state, and two died despite emergency ventriculostomy. Three had recurrent cysts following previous aspiration procedure. During the study period, patients underwent a total of 10 ventriculostomies, 10 aspirations, 26 microsurgical operations, and two shunt operations. Twenty-four of 26 microsurgical operations were transcallosal and two were transcortical. Twenty-four operations (22 transcallosal and two transfrontal approaches) without permanent morbidity were performed by four surgeons. Transient memory deficit from forniceal traction was noted in 26%. The remaining two transcallosal operations, which led to permanent morbidity or mortality, were performed by two different surgeons. Aspiration of cysts performed by four different surgeons carried a 40% risk of transient memory deficit (10% permanent) and an 80% recurrence rate. One patient was found to be cured on radiological studies obtained at the 5-year follow-up review. Seven cysts were followed by means of radiological studies with no treatment for 6 to 37 months. Five of these cysts grew, indicating that younger patients with colloid cysts will probably need surgical treatment. The main causes of unfavorable results were: 1) failure to investigate symptoms that proved fatal; 2) subtotal resection; and 3) surgical complications. Transcallosal microsurgery produced excellent results when performed by experienced surgeons. A colloid cyst of the foramen of Monro is a disease that should be detected before permanent neurological damage has occurred. Permanent morbidity or mortality should not be accepted in modern series of third ventricle colloid cysts.
Mathiesen
T
T
Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden.
Grane
P
P
Lindgren
L
L
Lindquist
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000175:diagnosis / Q000601:surgery; D002552:Cerebral Ventricles / Q000601:surgery*; D014695:Cerebral Ventriculography; D002648:Child; D002921:Cicatrix / Q000209:etiology; D003128:Coma / Q000209:etiology; D003560:Cysts / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006624:Hippocampus / Q000293:injuries; D006801:Humans; D001239:Inhalation; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D013238:Stereotaxic Techniques; D013530:Surgical Wound Infection / Q000209:etiology; D014057:Tomography, X-Ray Computed