Endoscopic removal of recurrent colloid cysts

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OBJECTIVE

Removal of colloid cysts of the third ventricle using a purely endoscopic method has been established as a safe and advantageous technique. It is hypothesized that endoscopic removal in recurrent cases might pose more technical challenges and result in less success. The objective of this study was to assess the feasibility and outcomes of using a purely endoscopic approach for the management of recurrent colloid cysts compared to primary cysts.

METHODS

A retrospective cohort study was performed on patients who underwent purely endoscopic removal of their colloid cyst. Descriptive statistics were compared for patients undergoing surgery for a recurrent cyst and those for a control cohort undergoing surgery for a primary cyst. Bivariate analysis was conducted using a Fisher’s exact test for categorical variables and Mann-Whitney U-test for continuous variables.

RESULTS

In total, 121 patients had a primary colloid cyst endoscopically removed and 10 patients had a total of 11 recurrent cysts removed. Recurrence or progression after surgery occurred in 3 (2.5%) cases in the primary cyst group and 2 (18.2%) cases in the recurrent cyst group. Symptomatic presentation during the follow-up period occurred in 6 (54.5%) cases in the recurrent cyst group versus 75 (62%) cases in the primary cyst group (p = 0.749). Two patients (20%) in the recurrent group had a second recurrence in a mean period of 30 months (1 patient at 15 and 1 patient at 45 months). One of these patients required a tertiary endoscopic removal 8 years after the second resection. No immediate postoperative complications or new morbidities were observed after repeat endoscopic surgery. The authors’ findings indicated a nonsignificant trend toward a higher recurrence rate (18.2% vs 2.5%, p = 0.055) and a decreased proportion of complete removal (90.9% vs 81.8%, p = 0.296) in the recurrent cyst group compared to the primary cyst group. However, a significantly higher rate of preoperative hydrocephalus was observed in the primary cyst group compared with the recurrent cyst group (63.6% vs 18.2%, p = 0.007).

CONCLUSIONS

Purely endoscopic approaches for the removal of recurrent colloid cysts of the third ventricle are feasible and equally safe compared with endoscopic removal of primary cysts. The study’s findings did not show a statistically significant difference in the rate of recurrence between the 2 groups. The proportion of patients with symptomatic cysts on presentation was lower in patients with recurrent cysts than in patients with primary cysts. Due to the high rate of complete removal with negligible morbidity, the authors continue to advocate for an endoscopic removal at the time of cyst recurrence.

ABBREVIATIONS EVD = externalized ventricular drain; FOR = frontal occipital horn ratio.

Article Information

Correspondence Mark M. Souweidane: NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, NY. mmsouwei@med.cornell.edu.

INCLUDE WHEN CITING Published online April 12, 2019; DOI: 10.3171/2018.12.JNS181859.

J.J.L.R. and R.U.C. contributed equally to this work.

Disclosures Mark M. Souweidane is a paid consultant for Aesculap, a division of B. Braun Melsungen AG.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative sagittal T1-weighted (A) and coronal T2-weighted (B) MR images displaying a recurrent colloid cyst. Postoperative sagittal (C) and coronal (D) contrast-enhanced T1-weighted MR images after complete secondary endoscopic removal of the recurrent cyst.

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    Right ventricular endoscopic view demonstrating the typical synechiae around a recurrent colloid cyst and choroidal fissure. ASV = anterior septal vein; CC = colloid cyst; CP = choroid plexus; ST = scar tissue. Figure is available in color online only.

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    Sagittal (left) and coronal (right) T2-weighted MR images displaying recurrent colloid cyst (white arrow) before tertiary endoscopic resection.

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    A right transforaminal view demonstrating limited exposure of the colloid cyst (A). A transchoroidal approach was utilized (B) by transecting the anterior septal vein to better visualize the colloid cyst (C). ASV = anterior septal vein; CC = colloid cyst; CP = choroid plexus; F = fornix; T = thalamus. Figure is available in color online only.

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    Postoperative T1-weighted MRI in axial (left) and coronal (right) views showing no remnant or residual cyst.

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