Stereotactic management of colloid cysts: factors predicting success

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  • 1 Department of Neurological Surgery, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
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✓ Stereotactic aspiration is a valuable surgical alternative for colloid cysts when used alone or in conjunction with microsurgical resection. Since 1981, the authors have performed computerized tomography (CT)-guided stereotactic aspiration as the initial procedure in 22 patients with colloid cysts; stereotactic aspiration alone was successful in 11 patients (50%). Of the 11 patients in whom aspiration failed, stereotactic endoscopic resection was attempted in three and was successful in one. Seven patients required a craniotomy and microsurgical removal of the cyst performed via a transcortical approach.

The preoperative CT appearance in eight cases of a hypodense or isodense cyst correlated favorably with successful aspiration of the cyst in six patients. A hyperdense appearance on the preoperative CT scan in 14 cases was associated with subtotal aspiration in 13 patients; five required craniotomy for removal. Preoperative magnetic resonance (MR) imaging in eight patients provided excellent anatomical definition of the cyst and its relationship to other structures of the third ventricle, but it was not possible to correlate successful aspiration with cyst appearance on MR images with short or long relaxation time sequences. The authors' 9-year experience suggests that preoperative CT studies accurately determine size, predict viscosity, and help to define a group of colloid cyst patients for whom stereotactic cyst aspiration will likely be successful. Unsuccessful stereotactic aspiration was related to two features: the high viscosity of the intracystic colloid material (nine patients), or deviation of the cyst away from the aspiration needle due to small cyst volume (two patients). Because of its simplicity and low risk, stereotactic surgery can be offered to selected patients as the initial procedure of choice. Craniotomy can be reserved for those whose imaging studies predict failure or for those whose cyst cannot be aspirated.

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  • 1.

    Abernathey CD, , David DH, & Kelly PJ: Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy. J Neurosurg 70:195200, 1989 Abernathey CD, David DH, Kelly PJ: Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy. J Neurosurg 70:195–200, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Antunes JL, , Louis KM, & Ganti SR: Colloid cysts of the third ventricle. Neurosurgery 7:450455, 1980 Antunes JL, Louis KM, Ganti SR: Colloid cysts of the third ventricle. Neurosurgery 7:450–455, 1980

    • Search Google Scholar
    • Export Citation
  • 3.

    Apuzzo MLJ: Surgery of masses affecting the third ventricular chamber: technique and strategies. Clin Neurosurg 34:499522, 1988 Apuzzo MLJ: Surgery of masses affecting the third ventricular chamber: technique and strategies. Clin Neurosurg 34:499–522, 1988

    • Search Google Scholar
    • Export Citation
  • 4.

    Apuzzo MLJ, , Chandrasoma PT, & Zelman V, et al: Computed tomographic guidance in the management of lesions of the third ventricular region. Neurosurgery 15:502508, 1984 Apuzzo MLJ, Chandrasoma PT, Zelman V, et al: Computed tomographic guidance in the management of lesions of the third ventricular region. Neurosurgery 15:502–508, 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    Batnitzky S, , Sarwar M, & Leeds NE, et al: Colloid cysts of the third ventricle. Radiology 112:327341, 1974 Batnitzky S, Sarwar M, Leeds NE, et al: Colloid cysts of the third ventricle. Radiology 112:327–341, 1974

    • Search Google Scholar
    • Export Citation
  • 6.

    Bosch DA, , Rähn T, & Backlund EO: Treatment of colloid cysts of the third ventricle by stereotactic aspiration. Surg Neurol 9:1518, 1978 Bosch DA, Rähn T, Backlund EO: Treatment of colloid cysts of the third ventricle by stereotactic aspiration. Surg Neurol 9:15–18, 1978

    • Search Google Scholar
    • Export Citation
  • 7.

    Bullard DE, , Osborne D, & Cook WA: Colloid cyst of the third ventricle presenting as a ring-enhancing lesion on computed tomography. Neurosurgery 11:790791, 1982 Bullard DE, Osborne D, Cook WA: Colloid cyst of the third ventricle presenting as a ring-enhancing lesion on computed tomography. Neurosurgery 11:790–791, 1982

    • Search Google Scholar
    • Export Citation
  • 8.

    Camacho A, , Abernathey CD, & Kelly PJ, et al: Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurgery 24:693700, 1989 Camacho A, Abernathey CD, Kelly PJ, et al: Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurgery 24:693–700, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Chan RC, & Thompson GB: Third ventricular colloid cysts presenting with acute neurological deterioration. Surg Neurol 19:358362, 1983 Chan RC, Thompson GB: Third ventricular colloid cysts presenting with acute neurological deterioration. Surg Neurol 19:358–362, 1983

    • Search Google Scholar
    • Export Citation
  • 10.

    Donaldson JO, & Simon RH: Radiodense ions within a third ventricular colloid cyst. Arch Neurol 37:246, 1980 Donaldson JO, Simon RH: Radiodense ions within a third ventricular colloid cyst. Arch Neurol 37:246, 1980

    • Search Google Scholar
    • Export Citation
  • 11.

    Donauer E, , Moringlane JR, & Ostertag CB: Colloid cysts of the third ventricle. Open operative approach or stereotactic aspiration? Acta Neurochir 83:2430, 1986 Donauer E, Moringlane JR, Ostertag CB: Colloid cysts of the third ventricle. Open operative approach or stereotactic aspiration? Acta Neurochir 83:24–30, 1986

    • Search Google Scholar
    • Export Citation
  • 12.

    Ganti SR, , Antunes JL, & Louis KM, et al: Computed tomography in the diagnosis of colloid cysts of the third ventricle. Radiology 138:385391, 1981 Ganti SR, Antunes JL, Louis KM, et al: Computed tomography in the diagnosis of colloid cysts of the third ventricle. Radiology 138:385–391, 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Guner M, , Shaw MDM, & Turner JW, et al: Computed tomography in the diagnosis of colloid cyst. Surg Neurol 6:345348, 1976 Guner M, Shaw MDM, Turner JW, et al: Computed tomography in the diagnosis of colloid cyst. Surg Neurol 6:345–348, 1976

    • Search Google Scholar
    • Export Citation
  • 14.

    Gutierrez-Lara F, , Patiño R, & Hakim S: Treatment of tumors of the third ventricle: a new and simple technique. Surg Neurol 3:323325, 1975 Gutierrez-Lara F, Patiño R, Hakim S: Treatment of tumors of the third ventricle: a new and simple technique. Surg Neurol 3:323–325, 1975

    • Search Google Scholar
    • Export Citation
  • 15.

    Hall WA, & Lunsford LD: Changing concepts in the treatment of colloid cysts. An 11-year experience in the CT era. J Neurosurg 66:186191, 1987 Hall WA, Lunsford LD: Changing concepts in the treatment of colloid cysts. An 11-year experience in the CT era. J Neurosurg 66:186–191, 1987

    • Search Google Scholar
    • Export Citation
  • 16.

    Jeeves MA, , Simpson DA, & Geffen G: Functional consequences of the transcallosal removal of intraventricular tumors. J Neurol Neurosurg Psychiatry 42:134142, 1979 Jeeves MA, Simpson DA, Geffen G: Functional consequences of the transcallosal removal of intraventricular tumors. J Neurol Neurosurg Psychiatry 42:134–142, 1979

    • Search Google Scholar
    • Export Citation
  • 17.

    Kondziolka D, & Bilbao JM: An immunohistochemical study of neuroepithelial (colloid) cysts. J Neurosurg 71:9197, 1989 Kondziolka D, Bilbao JM: An immunohistochemical study of neuroepithelial (colloid) cysts. J Neurosurg 71:91–97, 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Lunsford LD, , Levine G, & Gumerman LW: Comparison of computerized tomographic and radionuclide methods in determining intracranial cystic tumor volumes. J Neurosurg 63:740744, 1985 Lunsford LD, Levine G, Gumerman LW: Comparison of computerized tomographic and radionuclide methods in determining intracranial cystic tumor volumes. J Neurosurg 63:740–744, 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    Michels LG, & Rutz D: Colloid cysts of the third ventricle. A radiologic-pathologic correlation. Arch Neurol 39:640643, 1982 Michels LG, Rutz D: Colloid cysts of the third ventricle. A radiologic-pathologic correlation. Arch Neurol 39:640–643, 1982

    • Search Google Scholar
    • Export Citation
  • 20.

    Mohadjer M, , Teshmar E, & Mundinger F: CT-stereotaxic drainage of colloid cysts in the foramen of Monro and the third ventricle. J Neurosurg 67:220223, 1987 Mohadjer M, Teshmar E, Mundinger F: CT-stereotaxic drainage of colloid cysts in the foramen of Monro and the third ventricle. J Neurosurg 67:220–223, 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    Musolino A, , Fosse S, & Munari C, et al: Diagnosis and treatment of colloid cysts of the third ventricle by stereotactic drainage. Report on eleven cases. Surg Neurol 32:294299, 1989 Musolino A, Fosse S, Munari C, et al: Diagnosis and treatment of colloid cysts of the third ventricle by stereotactic drainage. Report on eleven cases. Surg Neurol 32:294–299, 1989

    • Search Google Scholar
    • Export Citation
  • 22.

    Nitta M, & Symon L: Colloid cysts of the third ventricle. A review of 36 cases. Acta Neurochir 76:99104, 1985 Nitta M, Symon L: Colloid cysts of the third ventricle. A review of 36 cases. Acta Neurochir 76:99–104, 1985

    • Search Google Scholar
    • Export Citation
  • 23.

    Osborn AG, & Wing SD: Thin-section computed tomography in the evaluation of third ventricular colloid cysts. Radiology 124:257258, 1977 Osborn AG, Wing SD: Thin-section computed tomography in the evaluation of third ventricular colloid cysts. Radiology 124:257–258, 1977

    • Search Google Scholar
    • Export Citation
  • 24.

    Powell MP, , Torrens MJ, & Thomson JLG, et al: Isodense colloid cysts of the third ventricle: a diagnosis and therapeutic problem resolved by ventriculoscopy. Neurosurgery 13:234237, 1983 Powell MP, Torrens MJ, Thomson JLG, et al: Isodense colloid cysts of the third ventricle: a diagnosis and therapeutic problem resolved by ventriculoscopy. Neurosurgery 13:234–237, 1983

    • Search Google Scholar
    • Export Citation
  • 25.

    Rivas JJ, & Lobato RD: CT-assisted stereotaxic aspiration of colloid cysts of the third ventricle. J Neurosurg 62:238243, 1985 Rivas JJ, Lobato RD: CT-assisted stereotaxic aspiration of colloid cysts of the third ventricle. J Neurosurg 62:238–243, 1985

    • Search Google Scholar
    • Export Citation
  • 26.

    Sackett JF, , Messina AV, & Petito CK: Computed tomography and magnification vertebral angiotomography in the diagnosis of colloid cysts of the third ventricle. Radiology 116:95100, 1975 Sackett JF, Messina AV, Petito CK: Computed tomography and magnification vertebral angiotomography in the diagnosis of colloid cysts of the third ventricle. Radiology 116:95–100, 1975

    • Search Google Scholar
    • Export Citation
  • 27.

    Shucart WA, & Stein BM: Transcallosal approach to the anterior ventricular system. Neurosurgery 3:339343, 1978 Shucart WA, Stein BM: Transcallosal approach to the anterior ventricular system. Neurosurgery 3:339–343, 1978

    • Search Google Scholar
    • Export Citation
  • 28.

    Zilkha A: Computed tomography of colloid cysts of the third ventricle. Clin Radiol 32:397401, 1981 Zilkha A: Computed tomography of colloid cysts of the third ventricle. Clin Radiol 32:397–401, 1981

    • Search Google Scholar
    • Export Citation

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