Combination of Neuroendoscopic and Stereotactic Procedures for Total Resection of Colloid Cysts with Favorable Neurological and Cognitive Outcomes.
BACKGROUND
Despite a wide range of surgical procedures, an unresolved debate remains regarding which attempt is optimal for the treatment of colloid cysts in the third ventricle. In this article, we present a new combination of stereotactic and endoscopic techniques.


METHODS
This prospective study includes 27 consecutive patients with symptomatic primary and recurrent colloid cysts. All cysts were removed via a neuroendoscope through a rostral transfrontal, transforaminal approach. The endoscope was supported by an additional cannula fixed in the stereotactic frame. Both tools were inserted into one lateral ventricle through two separate burr holes using stereotactic guidance.


RESULTS
The median operating time was 135 minutes. All cysts were removed completely, and no mortality or permanent complications related to surgery occurred. The mean time of observation was 43.5 months (range, 3-78 months), and no clinical or radiologic recurrences were observed. One patient with a history of an infected ventriculoperitoneal shunt did not improve after cyst removal, but improved after subsequent reimplantation of the shunt. In all other cases, symptoms resolved (67%) or decreased (30%). Cognitive functions improved or remained unchanged in all 10 elective cases examined neuropsychologically before and after surgery.


CONCLUSIONS
The techniques we describe for removal of colloid cysts are safe and effective, even for recurrent cases, and they provide 100% total resection, favorable cognitive outcomes, low risk of recurrence, and low risk of morbidity. The disadvantages of this method are a longer time for surgery and the need for more complex instrumentation compared with conventional endoscopic resection.
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland. Electronic address: mbirski@poczta.fm.
Marcin
M
Birski
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Julita
J
Birska
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Dariusz
D
Paczkowski
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Jacek
J
Furtak
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Marcin
M
Rusinek
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Marcin
M
Rudas
Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.
Marek
M
Harat
D000293:Adolescent; D000328:Adult; D000368:Aged; D056364:Colloid Cysts / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000295:instrumentation* / Q000379:methods*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011446:Prospective Studies; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Colloid cyst; Hydrocephalus; Neuroendoscopy; Stereotaxic techniques; Third ventricle