Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection

Thomas L. BeaumontDepartment of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri

Search for other papers by Thomas L. Beaumont in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
David D. Limbrick Jr.Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri

Search for other papers by David D. Limbrick Jr. in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Bhuvic PatelDepartment of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri

Search for other papers by Bhuvic Patel in
Current site
Google Scholar
PubMed
Close
 MD
,
Michael R. ChicoineDepartment of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri

Search for other papers by Michael R. Chicoine in
Current site
Google Scholar
PubMed
Close
 MD
,
Keith M. RichDepartment of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri

Search for other papers by Keith M. Rich in
Current site
Google Scholar
PubMed
Close
 MD
, and
Ralph G. Dacey Jr.Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri

Search for other papers by Ralph G. Dacey Jr. in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Colloid cysts of the third ventricle are histologically benign lesions that can cause obstructive hydrocephalus and death. Historically, colloid cysts have been removed by open microsurgical approaches. More recently, minimally invasive endoscopic and port-based techniques have offered decreased complications and length of stay, with improved patient satisfaction.

METHODS

A single-center retrospective analysis of patients with colloid cysts who underwent surgery at a large tertiary care hospital was performed. The cohort was assessed based on the surgical approach, comparing endoscopic resection to open microsurgical resection. The primary endpoint was rate of perioperative complications. Univariate analysis was used to assess several procedure-related variables and the cost of treatment. Multivariate analysis was used to assess predictors of perioperative complications. Total inpatient cost for each case was extracted from the health system financial database.

RESULTS

The study included 78 patients with colloid cysts who underwent resection either via an endoscopic approach (n = 33) or through a craniotomy (n = 45) with an interhemispheric-transcallosal or transcortical-transventricular approach. Nearly all patients were symptomatic, and half had obstructive hydrocephalus. Endoscopic resection was associated with reduced operative time (3.2 vs 4.9 hours, p < 0.001); lower complication rate (6.1% vs 33.1%, p = 0.009); reduced length of stay (4.1 vs 8.9 days, p < 0.001); and improved discharge to home (100% vs 75.6%, p = 0.008) compared to microsurgical resection. Coagulated residual cyst wall remnants were more common after endoscopic resection (63.6% vs 19.0%, p < 0.001) although this was not associated with a significantly increased rate of reoperation for recurrence. The mean follow-up was longer in the microsurgical resection group (3.1 vs 4.9 years, p = 0.016). The total inpatient cost of endoscopic resection was, on average, one-half (47%) that of microsurgical resection. When complications were encountered, the total inpatient cost of microsurgical resection was 4 times greater than that of endoscopic resection where no major complications were observed. The increased cost-effectiveness of endoscopic resection remained during reoperation.

CONCLUSIONS

Endoscopic resection of colloid cysts of the third ventricle offers a significant reduction in perioperative complications when compared to microsurgical resection. Endoscopic resection optimizes nearly all procedure-related variables compared to microsurgical resection, and reduces total inpatient cost by > 50%. However, endoscopic resection is associated with a significantly increased likelihood of residual coagulated cyst wall remnants that could increase the rate of reoperation for recurrence. Taken together, endoscopic resection represents a safe and effective minimally invasive approach for removal of colloid cysts.

ABBREVIATIONS

CCRS = Colloid Cyst Risk Score; EOR = extent of resection; EVD = external ventricular drain; IHTC = interhemispheric-transcallosal; LOS = length of stay; TCTV = transcortical-transventricular; VTE = venous thromboembolism.
  • Collapse
  • Expand

Illustration from Di Somma et al. (pp 1187–1190). Published with permission from Glia Media | Artist: Martha Headworth, MS.

  • 1

    Hernesniemi J, Romani R, Dashti R, et al. Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach—experience of 134 patients. Surg Neurol. 2008;69(5):447456.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Beaumont TL, Limbrick DD Jr, Rich KM, Wippold FJ II, Dacey RG Jr. Natural history of colloid cysts of the third ventricle. J Neurosurg. 2016;125(6):14201430.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Camacho A, Abernathey CD, Kelly PJ, Laws ER Jr. Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurgery. 1989;24(5):693700.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    King WA, Ullman JS, Frazee JG, Post KD, Bergsneider M. Endoscopic resection of colloid cysts: surgical considerations using the rigid endoscope. Neurosurgery. 1999;44(5):11031111.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Desai KI, Nadkarni TD, Muzumdar DP, Goel AH. Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surg Neurol. 2002;57(5):295304.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Milligan BD, Meyer FB. Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience. Neurosurgery. 2010;67(6):14831496.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Sheikh AB, Mendelson ZS, Liu JK. Endoscopic versus microsurgical resection of colloid cysts: a systematic review and meta-analysis of 1,278 patients. World Neurosurg. 2014;82(6):11871197.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Grondin RT, Hader W, MacRae ME, Hamilton MG. Endoscopic versus microsurgical resection of third ventricle colloid cysts. Can J Neurol Sci. 2007;34(2):197207.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    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. 1994;81(2):174178.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    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. 2010;66(2):368375.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Margetis K, Christos PJ, Souweidane M. Endoscopic resection of incidental colloid cysts. J Neurosurg. 2014;120(6):12591267.

  • 12

    Sribnick EA, Dadashev VY, Miller BA, Hawkins S, Hadjipanayis CG. Neuroendoscopic colloid cyst resection: a case cohort with follow-up and patient satisfaction. World Neurosurg. 2014;81(3-4):584593.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Vorbau C, Baldauf J, Oertel J, Gaab MR, Schroeder HWS. Long-term results after endoscopic resection of colloid cysts. World Neurosurg. 2019;122:e176e185.

  • 14

    Horn EM, Feiz-Erfan I, Bristol RE, et al. Treatment options for third ventricular colloid cysts: comparison of open microsurgical versus endoscopic resection. Neurosurgery. 2007;60(4):613620.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kehler U, Brunori A, Gliemroth J, et al. Twenty colloid cysts—comparison of endoscopic and microsurgical management. Minim Invasive Neurosurg. 2001;44(3):121127.

  • 16

    Boogaarts H, El-Kheshin S, Grotenhuis J. Endoscopic colloid cyst resection: technical note. Minim Invasive Neurosurg. 2011;54(2):9597.

  • 17

    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. 2003;52(3):525533.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Longatti P, Godano U, Gangemi M, et al. Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts. Childs Nerv Syst. 2006;22(10):12631267.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Samadian M, Ebrahimzadeh K, Maloumeh EN, et al. Colloid cyst of the third ventricle: long-term results of endoscopic management in a series of 112 cases. World Neurosurg. 2018;111:e440e448.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Boogaarts HD, Decq P, Grotenhuis JA, et al. Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases. Neurosurgery. 2011;68(1):179187.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Hoffman CE, Savage NJ, Souweidane MM. The significance of cyst remnants after endoscopic colloid cyst resection: a retrospective clinical case series. Neurosurgery. 2013;73(2):233239.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Isaacs AM, Bezchlibnyk YB, Dronyk J, Urbaneja G, Yong H, Hamilton MG. Long-term outcomes of endoscopic third ventricle colloid cyst resection: case series with a proposed grading system. Oper Neurosurg (Hagerstown). 2020;19(2):134142.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    de Witt Hamer PC, Verstegen MJ, De Haan RJ, et al. High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg. 2002;96(6):10411045.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Pollock BE, Huston J III. Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg. 1999;91(3):364369.

  • 25

    Pollock BE, Schreiner SA, Huston J III. A theory on the natural history of colloid cysts of the third ventricle. Neurosurgery. 2000;46(5):10771083.

  • 26

    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. J Neurosurg. 2009;110(1):112115.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Connolly ID, Johnson E, Lamsam L, Veeravagu A, Ratliff J, Li G. Microsurgical vs. endoscopic excision of colloid cysts: an analysis of complications and costs using a longitudinal administrative database. Front Neurol. 2017;8:259.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Greenlee JD, Teo C, Ghahreman A, Kwok B. Purely endoscopic resection of colloid cysts. Neurosurgery. 2008;62(3)(suppl 1):5156.

  • 29

    Eichberg DG, Buttrick SS, Sharaf JM, et al. Use of tubular retractor for resection of colloid cysts: single surgeon experience and review of the literature. Oper Neurosurg (Hagerstown). 2019;16(5):571579.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Engh JA, Lunsford LD, Amin DV, et al. Stereotactically guided endoscopic port surgery for intraventricular tumor and colloid cyst resection. Neurosurgery. 2010;67(3 Suppl Operative):ons198ons205.

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2662 2662 70
Full Text Views 561 561 21
PDF Downloads 629 629 45
EPUB Downloads 0 0 0