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.

Headings

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.

  • View in gallery

    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.

  • View in gallery

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

  • View in gallery

    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.

  • View in gallery

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

References

  • 1

    Birski MBirska JPaczkowski DFurtak JRusinek MRudas M: Combination of neuroendoscopic and stereotactic procedures for total resection of colloid cysts with favorable neurological and cognitive outcomes. World Neurosurg 85:2052142016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Boogaarts HDDecq PGrotenhuis JALe Guérinel CNseir RJarraya B: Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases. Neurosurgery 68:1791872011

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

    Chibbaro SChampeaux CPoczos PCardarelli MDi Rocco FIaccarino C: Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study. Neurosurg Rev 37:2352412014

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

    Decq PLe Guerinel CBrugières PDjindjian MSilva DKéravel Y: Endoscopic management of colloid cysts. Neurosurgery 42:128812961998

  • 5

    Greenlee JDTeo CGhahreman AKwok B: Purely endoscopic resection of colloid cysts. Neurosurgery 62 (3 Suppl 1):51562008

  • 6

    Grondin RTHader WMacRae MEHamilton MG: Endoscopic versus microsurgical resection of third ventricle colloid cysts. Can J Neurol Sci 34:1972072007

  • 7

    Harris PATaylor RThielke RPayne JGonzalez NConde JG: Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:3773812009

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

    Hellwig DBauer BLSchulte MGatscher SRiegel TBertalanffy H: Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery 52:5255332003

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

    Hoffman CESavage NJSouweidane MM: The significance of cyst remnants after endoscopic colloid cyst resection: a retrospective clinical case series. Neurosurgery 73:2332392013

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

    Horn EMFeiz-Erfan IBristol RELekovic GPGoslar PWSmith KA: Treatment options for third ventricular colloid cysts: comparison of open microsurgical versus endoscopic resection. Neurosurgery 60:6136202007

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

    Kehler UBrunori AGliemroth JNowak GDelitala AChiappetta F: Twenty colloid cysts—comparison of endoscopic and microsurgical management. Minim Invasive Neurosurg 44:1211272001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Levine NBMiller MNCrone KR: Endoscopic resection of colloid cysts: indications, technique, and results during a 13-year period. Minim Invasive Neurosurg 50:3133172007

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

    Longatti PGodano UGangemi MDelitala AMorace EGenitori L: Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts. Childs Nerv Syst 22:126312672006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Margetis KChristos PJSouweidane M: Endoscopic resection of incidental colloid cysts. J Neurosurg 120:125912672014

  • 15

    Mishra SChandra PSSuri ARajender KSharma BSMahapatra AK: Endoscopic management of third ventricular colloid cysts: eight years’ institutional experience and description of a new technique. Neurol India 58:4124172010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    O’Hayon BBDrake JMOssip MGTuli SClarke M: Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 29:2452491998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Qiao LSouweidane MM: Purely endoscopic removal of intraventricular brain tumors: a consensus opinion and update. Minim Invasive Neurosurg 54:1491542011

  • 18

    Schroeder HWGaab MR: Endoscopic resection of colloid cysts. Neurosurgery 51:144114452002

  • 19

    Souweidane MM: Endoscopic surgery for intraventricular brain tumors in patients without hydrocephalus. Neurosurgery 57 (4 Suppl):3123182005

  • 20

    Sribnick EADadashev VYMiller BAHawkins SHadjipanayis CG: Neuroendoscopic colloid cyst resection: a case cohort with follow-up and patient satisfaction. World Neurosurg 81:5845932014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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