Complete microsurgical resection of colloid cysts with a dual-port endoscopic technique.
OBJECTIVE
A dual-port endoscopic approach, used for the surgical management of colloid cysts, was developed with the following goals: 1) a direct, unobstructed, high-illumination endoscopic view of the attachment point of the colloid cyst to the tela choroidea, and 2) a gross total resection of the colloid cyst capsule using microsurgical techniques.


METHODS
Eleven symptomatic, hydrocephalic, colloid cyst patients who underwent operation with a unilateral, precoronal-frontopolar dual-port endoscopic technique were retrospectively assessed. Preoperative magnetic resonance imaging scans were analyzed, comparing the lateral precoronal to the frontopolar approach, to determine the degree of angulation that would be required to directly view the roof of the third ventricle. Clinical outcome and radiographical follow-up were assessed.


RESULTS
The frontopolar approach achieved an approach angle to the roof of the third ventricle of only 15 +/- 4 degrees compared with 56 +/- 6 degrees (P < 0.0001) for the precoronal approach. The view obtained from the frontopolar endoscope allowed excellent visualization of the cyst attachment point. Microsurgical dissection techniques, using many standard microsurgical instruments introduced through the second port, were satisfactorily accomplished. Complete resections were obtained in 10 out of 11 dual-port patients. Worsening of memory deficits occurred in one patient. There was no cyst recurrence with a mean follow-up period of 26 +/- 27 months.


CONCLUSIONS
The dual-port endoscopic technique described is an alternative to classic microsurgical craniotomy approaches. The technique allows excellent visualization of the colloid cyst attachment and permits microdissection techniques.
Bergsneider
Marvin
M
Division of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-6901, USA. mbergsneider@mednet.ucla.edu
D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000601:surgery*; D020863:Central Nervous System Cysts / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D020542:Third Ventricle / Q000601:surgery; D016896:Treatment Outcome