title: Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts.
abstract: Colloid cysts are histologically benign lesions whose primary goal of treatment should be complete resection to avoid recurrence and sudden death. Open surgery is traditionally considered the standard approach, but, recently, the endoscopic technique has been recognized as a viable and safe alternative to microsurgery. The endoscopic approach to colloid cysts of the third ventricle is usually performed through the foramen of Monro. However, this route does not provide adequate visualization of the cyst attachment on the tela choroidea. The combined endoscopic transforaminal-transchoroidal approach (ETTA), providing exposure of the entire cyst and a better visualization of the tela choroidea, could increase the chances of achieving a complete cyst resection. Between April 2005 and February 2011, 19 patients with symptomatic colloid cyst of the third ventricle underwent an endoscopic transfrontal-transforaminal approach. Five of these patients, harboring a cyst firmly adherent to the tela choroidea or attached to the middle/posterior roof of the third ventricle, required a combined ETTA. Postoperative MRI documented a gross-total resection in all 5 cases. There were no major complications and only 1 patient experienced a transient worsening of the memory deficit. To date, no cyst recurrence has been observed. An ETTA is a minimally invasive procedure that can allow for a safe and complete resection of third ventricle colloid cysts, even in cases in which the lesions are firmly attached to the tela choroidea or located in the middle/posterior roof of the third ventricle.
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacoangeli
authors.forename: Lucia Giovanna Maria
authors.initials: LG
authors.lastname: di Somma
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Rienzo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Alvaro
authors.forename: Davide
authors.initials: D
authors.lastname: Nasi
authors.forename: Massimo
authors.initials: M
authors.lastname: Scerrati
mesh_terms: D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles; D002831:Choroid Plexus; D056364:Colloid Cysts / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ETTA = endoscopic transforaminal-transchoroidal approach; minimally invasive surgery; neuroendoscopy; surgical technique; tenia fornicis; third ventricle colloid cyst; transchoroidal approach