Natural history of asymptomatic colloid cysts of the third ventricle

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Object. To determine the natural history of colloid cysts of the third ventricle in patients in whom the cysts were incidentally discovered, the authors retrospectively reviewed cases observed during the modern neuroimaging era (1974–1998).

Methods. During this 25-year interval, 162 patients with colloid cysts were examined and cared for at our center. Sixty-eight patients (42%) were thought to be asymptomatic with regard to their colloid cyst and observation with serial neuroimaging was recommended. The mean patient age was 57 years at the time of diagnosis (range 7–88 years) and the mean cyst size was 8 mm (range 4–18 mm). Computerized tomography scanning revealed a hyperdense cyst in 49 (84%) of 58 patients. Three patients were excluded from the study because they died of unrelated causes within 6 months of scanning and seven patients were lost to follow-up review. Clinical follow-up evaluation was available at a mean of 79 months (range 7–268 months) in the remaining 58 patients. The numbers of patients who participated in follow-up review at 2, 5, and 10 years after diagnosis were 40, 28, and 14, respectively. The incidences of symptomatic progression related to the cyst were 0%, 0%, and 8% at 2, 5, and 10 years, respectively. No patient died suddenly during the follow-up interval. Two (6%) of 34 patients in whom follow-up imaging was performed either exhibited cyst growth (one patient) or experienced hydrocephalus (one patient) at a mean of 41 months after diagnosis (range 4–160 months).

Conclusions. Patients in whom asymptomatic colloid cysts are diagnosed can be cared for safely with observation and serial neuroimaging. If a patient becomes symptomatic, the cyst enlarges, or hydrocephalus develops, prompt neurosurgical intervention is necessary to prevent the occurrence of neurological decline from these benign tumors.

Article Information

Address reprint requests to: Bruce E. Pollock, M.D, Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55901.

© AANS, except where prohibited by US copyright law.

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    Graph displaying the actuarial incidence of cyst-related symptom development.

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    Coronal gadolinium-enhanced MR images obtained in a 66-year old man who sustained a cerebral infarction and was found incidentally to have a 5-mm colloid cyst. Upper: Image obtained at the time of diagnosis. Lower: Image obtained 84 months later revealing that the size of the cyst and the degree of ventricular dilation are unchanged. Cerebral lymphoma (note enhancement in the left frontal lobe) was diagnosed and the patient died 3 months after the second MR image had been obtained.

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