Endoscopic approach to colloid cyst: what is the optimal entry point and trajectory?

Clinical article

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  • 1 Division of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
  • 2 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Object

An optimal entry point and trajectory for endoscopic colloid cyst (ECC) resection helps to protect important neurovascular structures. There is a large discrepancy in the entry point and trajectory in the neuroendoscopic literature.

Methods

Trajectory views from MRI or CT scans used for cranial image guidance in 39 patients who had undergone ECC resection between July 2004 and July 2010 were retrospectively evaluated. A target point of the colloid cyst was extended out to the scalp through a trajectory carefully observed in a 3D model to ensure that important anatomical structures were not violated. The relation of the entry point to the midline and coronal sutures was established. Entry point and trajectory were correlated with the ventricular size.

Results

The optimal entry point was situated 42.3 ± 11.7 mm away from the sagittal suture, ranging from 19.1 to 66.9 mm (median 41.4 mm) and 46.9 ± 5.7 mm anterior to the coronal suture, ranging from 36.4 to 60.5 mm (median 45.9 mm). The distance from the entry point to the target on the colloid cyst varied from 56.5 to 78.0 mm, with a mean value of 67.9 ± 4.8 mm (median 68.5 mm). Approximately 90% of the optimal entry points are located 40–60 mm in front of the coronal suture, whereas their perpendicular distance from the midline ranges from 19.1 to 66.9 mm. The location of the “ideal” entry points changes laterally from the midline as the ventricles change in size.

Conclusions

The results suggest that the optimal entry for ECC excision be located at 42.3 ± 11.7 mm perpendicular to the midline, and 46.9 ± 5.7 mm anterior to the coronal suture, but also that this point differs with the size of the ventricles. Intraoperative stereotactic navigation should be considered for all ECC procedures whenever it is available. The entry point should be estimated from the patient's own preoperative imaging studies if intraoperative neuronavigation is not available. An estimated entry point of 4 cm perpendicular to the midline and 4.5 cm anterior to the coronal suture is an acceptable alternative that can be used in patients with ventriculomegaly.

Abbreviations used in this paper:ECC = endoscopic colloid cyst; FH = frontal horns; ID = internal distance.

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Contributor Notes

Address correspondence to: Leonardo Rangel-Castilla, M.D., Division of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013. email: leonardo.rangel-castilla@bnaneuro.net.

Please include this information when citing this paper: published online June 13, 2014; DOI: 10.3171/2014.5.JNS132031.

  • 1

    Abdou MS, & Cohen AR: Endoscopic treatment of colloid cysts of the third ventricle. Technical note and review of the literature. J Neurosurg 89:10621068, 1998

    • Search Google Scholar
    • Export Citation
  • 2

    Acerbi F, , Rampini P, , Egidi M, , Locatelli M, , Borsa S, & Gaini SM: Endoscopic treatment of colloid cysts of the third ventricle: long-term results in a series of 6 consecutive cases. J Neurosurg Sci 51:5360, 2007

    • Search Google Scholar
    • Export Citation
  • 3

    Antunes JL, , Louis KM, & Ganti SR: Colloid cysts of the third ventricle. Neurosurgery 7:450455, 1980

  • 4

    Batnitzky S, , Sarwar M, , Leeds NE, , Schechter MM, & Azar-Kia B: Colloid cysts of the third ventricle. Radiology 112:327341, 1974

  • 5

    Boogaarts H, , El-Kheshin S, & Grotenhuis J: Endoscopic colloid cyst resection: technical note. Minim Invasive Neurosurg 54:9597, 2011

  • 6

    Boogaarts HD, , Decq P, , Grotenhuis JA, , Le Guérinel C, , Nseir R, & Jarraya B, : Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases. Neurosurgery 68:179187, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    Chen F, & Nakaji P: Optimal entry point and trajectory for endoscopic third ventriculostomy: evaluation of 53 patients with volumetric imaging guidance. Clinical article. J Neurosurg 116:11531157, 2012

    • Search Google Scholar
    • Export Citation
  • 8

    de Witt Hamer PC, , Verstegen MJ, , De Haan RJ, , Vandertop WP, , Thomeer RT, & Mooij JJ, : High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg 96:10411045, 2002

    • Search Google Scholar
    • Export Citation
  • 9

    Decq P, , Le Guerinel C, , Brugières P, , Djindjian M, , Silva D, & Kéravel Y, : Endoscopic management of colloid cysts. Neurosurgery 42:12881296, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Deinsberger W, , Böker DK, & Samii M: Flexible endoscopes in treatment of colloid cysts of the third ventricle. Minim Invasive Neurosurg 37:1216, 1994

    • Search Google Scholar
    • Export Citation
  • 11

    Delitala A, , Brunori A, & Russo N: Supraorbital endoscopic approach to colloid cysts. Neurosurgery 69:2 Suppl Operative ons176ons183, 2011

    • Search Google Scholar
    • Export Citation
  • 12

    Desai KI, , Nadkarni TD, , Muzumdar DP, & Goel AH: Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surg Neurol 57:295304, 2002

    • Search Google Scholar
    • Export Citation
  • 13

    Engh JA, , Lunsford LD, , Amin DV, , Ochalski PG, , Fernandez-Miranda J, & Prevedello DM, : Stereotactically guided endoscopic port surgery for intraventricular tumor and colloid cyst resection. Neurosurgery 67:3 Suppl Operative ons198ons205, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Greenlee JD, , Teo C, , Ghahreman A, & Kwok B: Purely endoscopic resection of colloid cysts. Neurosurgery 62:3 Suppl 1 5156, 2008

  • 15

    Grondin RT, , Hader W, , MacRae ME, & Hamilton MG: Endoscopic versus microsurgical resection of third ventricle colloid cysts. Can J Neurol Sci 34:197207, 2007

    • Search Google Scholar
    • Export Citation
  • 16

    Hellwig D, , Bauer BL, , Schulte M, , Gatscher S, , Riegel T, & Bertalanffy H: Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery 52:525533, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Horn EM, , Feiz-Erfan I, , Bristol RE, , Lekovic GP, , Goslar PW, & Smith KA, : Treatment options for third ventricular colloid cysts: comparison of open microsurgical versus endoscopic resection. Neurosurgery 60:613620, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    King WA, , Ullman JS, , Frazee JG, , Post KD, & Bergsneider M: Endoscopic resection of colloid cysts: surgical considerations using the rigid endoscope. Neurosurgery 44:11031111, 1999

    • Search Google Scholar
    • Export Citation
  • 19

    Levine NB, , Miller MN, & Crone KR: Endoscopic resection of colloid cysts: indications, technique, and results during a 13-year period. Minim Invasive Neurosurg 50:313317, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Lewis AI, , Crone KR, , Taha J, , van Loveren HR, , Yeh HS, & Tew JM Jr: Surgical resection of third ventricle colloid cysts. Preliminary results comparing transcallosal microsurgery with endoscopy. J Neurosurg 81:174178, 1994

    • Search Google Scholar
    • Export Citation
  • 21

    Little JR, & MacCarty CS: Colloid cysts of the third ventricle. J Neurosurg 40:230235, 1974

  • 22

    Longatti P, , Martinuzzi A, , Moro M, , Fiorindi A, & Carteri A: Endoscopic treatment of colloid cysts of the third ventricle: 9 consecutive cases. Minim Invasive Neurosurg 43:118123, 2000

    • Search Google Scholar
    • Export Citation
  • 23

    Mishra S, , Chandra PS, , Suri A, , Rajender K, , Sharma BS, & Mahapatra AK: Endoscopic management of third ventricular colloid cysts: eight years' institutional experience and description of a new technique. Neurol India 58:412417, 2010

    • Search Google Scholar
    • Export Citation
  • 24

    Nitta M, & Symon L: Colloid cysts of the third ventricle. A review of 36 cases. Acta Neurochir (Wien) 76:99104, 1985

  • 25

    Powell MP, , Torrens MJ, , Thomson JL, & Horgan JG: Isodense colloid cysts of the third ventricle: a diagnostic and therapeutic problem resolved by ventriculoscopy. Neurosurgery 13:234237, 1983

    • Search Google Scholar
    • Export Citation
  • 26

    Rodziewicz GS, , Smith MV, & Hodge CJ Jr: Endoscopic colloid cyst surgery. Neurosurgery 46:655662, 2000

  • 27

    Sampath R, , Vannemreddy P, & Nanda A: Microsurgical excision of colloid cyst with favorable cognitive outcomes and short operative time and hospital stay: operative techniques and analyses of outcomes with review of previous studies. Neurosurgery 66:368375, 2010

    • Search Google Scholar
    • Export Citation
  • 28

    Shapiro S, , Rodgers R, , Shah M, , Fulkerson D, & Campbell RL: Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle. Clinical article. J Neurosurg 110:112115, 2009

    • Search Google Scholar
    • Export Citation
  • 29

    Souweidane MM, & Luther N: Endoscopic resection of solid intraventricular brain tumors. J Neurosurg 105:271278, 2006

  • 30

    Stachura K, , Libionka W, , Moskała M, , Krupa M, & Polak J: Colloid cysts of the third ventricle. Endoscopic and open microsurgical management. Neurol Neurochir Pol 43:251257, 2009

    • Search Google Scholar
    • Export Citation
  • 31

    Staub BN, , Rangel-Castilla L, , Olar A, & Baskin DS: Olfactory colloid cyst: case report and extraventricular colloid cyst literature review. World Neurosurg 81:202.e19202.e22, 2014

    • Search Google Scholar
    • Export Citation
  • 32

    Teo C: Complete endoscopic removal of colloid cysts: issues of safety and efficacy. Neurosurg Focus 6:4 E9, 1999

  • 33

    Wait SD, , Gazzeri R, , Wilson DA, , Abla AA, , Nakaji P, & Teo C: Endoscopic colloid cyst resection in the absence of ventriculomegaly. Neurosurgery 73:1 Suppl Operative ons39ons47, 2013

    • Search Google Scholar
    • Export Citation
  • 34

    Wilson DA, , Fusco DJ, , Wait SD, & Nakaji P: Endoscopic resection of colloid cyst: use of a dual-instrument technique and an anterolateral approach. World Neurosurgery 80:576583, 2013

    • Search Google Scholar
    • Export Citation
  • 35

    Zohdi A, & El Kheshin S: Endoscopic approach to colloid cysts. Minim Invasive Neurosurg 49:263268, 2006

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