Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle.
OBJECTIVE
Endoscopic surgery has been reported to be more cost-effective and safer than open craniotomy for resection of colloid cysts, despite a 5-10% conversion rate to craniotomy, a 5% recurrence rate, a 5-10% ventricular shunting rate, a 5-10% epilepsy rate, and a 3-4 day hospital stay. In 1985, the authors developed a interhemispheric, transcallosal, subchoroidal, fornix-sparing approach that allowed safe total resection of the colloid cyst and that appeared to be superior to the endoscopic approach. The long-term results are analyzed and compared with findings in the literature.


METHODS
Fifty-seven consecutive colloid cysts were totally removed via a 3 x3-in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix. The length of the callosotomy was 1.5-2 cm in all patients. The mean follow-up duration was 12 years (range 2-22 years). A retrospective analysis comparing the authors' results with those reported in the endoscopic literature was performed.


RESULTS
All patients had 1-year postoperative imaging studies (CT or MR imaging) documenting gross-total resection with no deaths, infection, hemiparesis, seizures, or disconnection syndrome. One surgery was complicated by bilateral subdural hematomas, which were successfully treated. There has been a zero recurrence rate. Three patients required a permanent ventriculoperitoneal shunt (including 2 who required emergency ventriculostomy before surgery). The mean hospital stay was 4.8 days (range 2-24 days). There was 1 patient with permanent short-term memory loss who presented with a herniation syndrome requiring emergency ventriculostomy.


CONCLUSIONS
The interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts is safe and led to a zero recurrence rate with no permanent neurological sequelae including epilepsy, and these results are superior to any reported results with endoscopy.
Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA. SShapiro@iupui.edu
Scott
S
Shapiro
Richard
R
Rodgers
Mitesh
M
Shah
Daniel
D
Fulkerson
Robert L
RL
Campbell
D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000601:surgery*; D003337:Corpus Callosum / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D020712:Fornix, Brain / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult