Colloid cysts of the third ventricle in children

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  • 1 Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York;
  • | 2 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida;
  • | 3 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • | 4 Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York; and
  • | 5 Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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OBJECTIVE

The rarity of colloid cysts in children makes it difficult to characterize this entity and offer meaningful advice on treatment. Infrequent case reports exist, but to date there has been no age-specific assessment. The purpose of this study was to define any differences between children and adults who are evaluated and treated for colloid cysts of the third ventricle.

METHODS

Patients with colloid cysts were reviewed and stratified by age. Individuals ≤ 18 years of age were defined as pediatric patients and those > 18 years of age as adults. Clinical and radiographic data, treatment, and postoperative outcomes were compared between both groups. Bivariate analysis was conducted using the Fisher exact test for categorical variables and Mann-Whitney U-test for continuous variables.

RESULTS

Of 132 endoscopic resections (121 primary, 10 secondary, and 1 tertiary) of a colloid cyst, 9 (6.8%) were performed in pediatric patients (mean age 14.1 years, range 9–18 years) and 123 (93.2%) were performed in adult patients (mean age 43.8 years, range 19–73 years). Cases were found incidentally more commonly in pediatric than adult patients (66.7% vs 37.4%, p > 0.05), and pediatric patients had lower rates of hydrocephalus than adult patients (11.1% vs 63.4%, p < 0.05). Acute decompensation at presentation was found in 8 adults (6.5%) but no children. Complete cyst removal (88.9% vs 90.2%, p > 0.05) and length of stay (1.6 days vs 2.9 days, p > 0.05) were not significantly different between the groups. Postoperative complications (6.5% in adults, 0% in children) and recurrence (2.4% in adults, 0% in children) were rare in both groups, and there were no treatment-related deaths. The mean postoperative radiological follow-up was longer in pediatric patients (45 months, range 4–89 months) than adults (44.1 months, range 1–171 months).

CONCLUSIONS

While differences exist between children and adults regarding colloid cyst presentation, these are in keeping with the predicted evolution of a slow-growing lesion. Consistent with this observation, children had lower rates of hydrocephalus and a smaller mean maximal cyst diameter. Contrary to the published literature, however, sudden deterioration was not observed in pediatric patients but occurred in adult patients. In this limited pediatric sample size, the authors have not recorded any postoperative complications or recurrences to date. These encouraging results with endoscopic removal may positively impact future decisions related to children given their protracted life expectancy and projected rates of progression.

ABBREVIATIONS

EVD = external ventricular drain; FOR = frontal occipital horn ratio.

Illustration showing the robotic equipment, with navigation and an electrode placed in the brain, used during robotic thermocoagulative hemispherotomy. The upper right image shows the electrode trajectory in the parasagittal section, and the lower right image shows the area of hemispheric disconnection. Artist: Sandeep Kandregula. See the article by Chandra et al. (pp 688–699).

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