1
|
Badran SA, Al-Juboori AA, Khasro MN, Alsamok AS, Shahadha AA. Third Ventricular Colloid Cyst, New Surgical Classification. World Neurosurg 2024:S1878-8750(24)00554-0. [PMID: 38599374 DOI: 10.1016/j.wneu.2024.03.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND This research discusses colloid cyst surgical concerns, with an emphasis on the value of a novel surgical classification based on anatomical sites. In the study, 59 patients who underwent surgical intervention between 2009 and 2022 and were diagnosed with colloid cysts via computed tomography scan and magnetic resonance imaging participated. METHODS There were more male cases than female ones (57.6%). The majority of patients presented with headache (79%), followed by abnormal gait (12%), visual blurring (5%), and seizures (4%). RESULTS In this study, we present a new surgical classification based on anatomical locations, distinguishing 4 types: open Monro type (50.84%), closed Monro type (23.72%), retroforaminal type (13.55%), and interforniceal type (11.86%). CONCLUSIONS In summary, the surgical classification that has been suggested provides significant insights into the varied anatomical sites where colloid cysts might be found. Microneurosurgeons significantly need to be oriented about the possible sites of colloid cysts through this classification to achieve complete and curative resection and reduce the likelihood of recurrence.
Collapse
Affiliation(s)
- Saif Anmar Badran
- Department of Surgery, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq.
| | | | | | - Ali Sabah Alsamok
- Department of Surgery, Dr. Saad AL-Witry Hospital for Neurosciences, Baghdad, Iraq
| | - Ali Akram Shahadha
- Department of Surgery, Dr. Saad AL-Witry Hospital for Neurosciences, Baghdad, Iraq
| |
Collapse
|
2
|
Saleem A, Najibullah M, Shabbir Z, Azab W. Endoscopic trans-septal interforniceal approach for excision of colloid cysts of the third ventricle using the rotational technique. Childs Nerv Syst 2023; 39:3373-3379. [PMID: 37173435 DOI: 10.1007/s00381-023-05990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Colloid cysts of the third ventricle are benign intracranial lesions that account for 0.5 to 2% of all brain tumors and are even rarer in pediatric population. Dandy was the first to successfully excise a colloid cyst of the third ventricle via a transcortical transventricular approach in 1921. For several decades to follow, the transcortical transventricular and transcallosal microsurgical approaches remained the cornerstone of surgical management of these lesions. With time and refinements in endoscopic equipment and techniques, endoscopic resection of colloid cysts evolved into a currently well-established and appealing minimally invasive alternative to microsurgery. Endoscopic endochannel techniques for colloid cysts of the third ventricle may either be transforaminal or trans-septal interforniceal, depending on the pathoanatomical features of the colloid cyst and its relation to the juxtaposed anatomical structures. The endoscopic trans-septal interforniceal approach is required to access the rare subset of colloid cysts that extend superior to the roof of the third ventricle between the two fornices insinuating themselves between the leaflets of the septum pellucidum. In this article, the surgical technique of the endochannel endoscopic trans-septal interforniceal approach is elaborated upon. A representative case is presented along with an operative video.
Collapse
Affiliation(s)
- Athary Saleem
- Department of Neurosurgery, Ibn Sina Hospital, Al-Sabah Medical Area, P.O. Box: 25427, 13115, Safat, Kuwait
| | - Mustafa Najibullah
- Department of Neurosurgery, Ibn Sina Hospital, Al-Sabah Medical Area, P.O. Box: 25427, 13115, Safat, Kuwait
| | - Zafdam Shabbir
- Department of Neurosurgery, Ibn Sina Hospital, Al-Sabah Medical Area, P.O. Box: 25427, 13115, Safat, Kuwait
| | - Waleed Azab
- Department of Neurosurgery, Ibn Sina Hospital, Al-Sabah Medical Area, P.O. Box: 25427, 13115, Safat, Kuwait.
| |
Collapse
|
3
|
Mansour MA, Khalil DF, Hamdi A, Bayoumi M, El-Salamoni MAF, Elsoulia A, Lasheen AA, Kamel AE, Nawara M, Ayad AA. Intraventricular sizeable colloid cyst with atypical radiological features: A case report and evidence-based review. Radiol Case Rep 2023; 18:3753-3758. [PMID: 37636536 PMCID: PMC10450352 DOI: 10.1016/j.radcr.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/02/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
Colloid cysts are benign intracranial lesions, typically located in the anterior portion of the third ventricle near the interventricular foramina of Monro. The cysts usually consist of an epithelial lining filled with viscous gelatinous material of various components. Colloid cysts are generally asymptomatic, but once symptomatic, they can present in a variety of ways, including headaches, vomiting, visual and memory problems, and vertigo. Colloid cysts present classically on imaging as a well-delineated hyperattenuating lesion on unenhanced radiological modalities. Herein, we report a case of a patient who presented with hydrocephalus caused by a sizeable colloid cyst which demonstrated atypical imaging findings in the form of hypodensity on CT and hyperintensity on T2WI, making them difficult to identify and easy to miss. Although this atypical imaging appearance is uncommon with yet unknown true incidence, it is prudent to be aware of it because early management of colloid cysts has a favorable outcome, in contrast to untreated cysts that are associated with higher rates of morbidity and mortality. Additionally, we provide a comprehensive, evidence-based review of the medical entity of intracranial colloid cysts with highlights of current postulated pathological theories and management algorithms.
Collapse
Affiliation(s)
- Moustafa A. Mansour
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Neurology and Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Neuro-Intensive Care, Dar Al-Fouad Medical Corporation, Cairo, Egypt
- Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Dyana F. Khalil
- Department of Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdou Hamdi
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahmoud Bayoumi
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ali Elsoulia
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Mohamed Nawara
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmad A. Ayad
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
4
|
Sefcikova V, Wong QHW, Samandouras G. Practical, Stereotactic, Low-Profile Technique for Transcortical/Transventricular Colloid Cyst Removal Independent of Ventricular Size: Technical Note and Analysis of Approaches. Oper Neurosurg (Hagerstown) 2023; 24:e61-e67. [PMID: 36637308 DOI: 10.1227/ons.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In the presence of a dilated foramen of Monro, a transcortical, transforaminal approach is considered the safest and simplest approach for resection of colloid cysts. However, in the presence of small or normal frontal horns, numerous microsurgical approaches and, often complicated, variations have been described, invariably employing forms of stereotactic navigation. OBJECTIVE To report an alternative, accurate, microsurgical stereotactic low-profile technique. METHODS The small frontal horn is stereotactically targeted as previously described. Routine equipment is used to accurately create a novel, rigid, atraumatic surgical corridor. RESULTS After a 7-mm corticotomy, a peel-away catheter carrying the AxiEM stylet engages the target set as the frontal horn. All joints of the endoscope holder are locked, allowing only catheter advancement (y axis) while lateral (x axis) or anteroposterior (z axis) movements are secure. Two, 7-mm retractor blades are inserted. The extremely consistent anatomy of the foramen of Monro allows en bloc microsurgical removal without unnecessary coagulation of cyst wall or choroid plexus. CONCLUSION Despite a plethora of approaches to the rostral third ventricle, in the presence of normal or small frontal horns, including creation of transcallosal/interforniceal, suprachoroidal (or transchoroidal), and sub-choroidal, colloid cyst resection does not necessarily need to be convoluted. Technical nuances of an accurate, practical, minimally invasive technique are described.
Collapse
Affiliation(s)
- Viktoria Sefcikova
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK.,The University of Queensland Medical School, Brisbane, QLD, Australia
| | - Queenie Hoi-Wing Wong
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.,Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - George Samandouras
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK.,Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| |
Collapse
|
5
|
Paun L, Lavé A, Patet G, Bartoli A. Supratentorial Pediatric Midline Tumors and Tumor-like Lesions: Clinical Spectrum, Natural History and Treatment Options. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040534. [PMID: 35455578 PMCID: PMC9032564 DOI: 10.3390/children9040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 04/10/2023]
Abstract
Childhood Central Nervous System tumors account for 25% of all pediatric tumors. Large availability and broadening of indications to imaging has made incidental findings more common. Among these, midline lesions have different clinical relevance depending on their intrinsic pattern of behaviour and on their specific location. In this narrative review we describe the natural history and treatment options of midline lesions in children.
Collapse
|
6
|
Roth J, Perekopaiko Y, Kozyrev DA, Constantini S. Pediatric colloid cysts: a multinational, multicenter study. An IFNE-ISPN-ESPN collaboration. J Neurosurg Pediatr 2022; 29:543-550. [PMID: 35148518 DOI: 10.3171/2021.12.peds21482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Colloid cysts (CCs) are rare at all ages, and particularly among children. The current literature on pediatric CC is limited, and often included in mixed adult/pediatric series. The goal of this multinational, multicenter study was to combine forces among centers and investigate the clinical course of pediatric CCs. METHODS A multinational, multicenter retrospective study was performed to attain a large sample size, focusing on CC diagnosis in patients younger than 18 years of age. Collected data included clinical presentation, radiological characteristics, treatment, and outcome. RESULTS One hundred thirty-four children with CCs were included. Patient age at diagnosis ranged from 2.4 to 18 years (mean 12.8 ± 3.4 years, median 13.2 years, interquartile range 10.3-15.4 years; 22% were < 10 years of age). Twenty-two cases (16%) were diagnosed incidentally, including 48% of those younger than 10 years of age. Most of the other patients had symptoms related to increased intracranial pressure and hydrocephalus. The average follow-up duration for the entire group was 49.5 ± 45.8 months. Fifty-nine patients were initially followed, of whom 28 were eventually operated on at a mean of 19 ± 32 months later due to cyst growth, increasing hydrocephalus, and/or new symptoms. There was a clear correlation between larger cysts and symptomatology, acuteness of symptoms, hydrocephalus, and need for surgery. Older age was also associated with the need for surgery. One hundred three children (77%) underwent cyst resection, 60% using a purely endoscopic approach. There was 1 death related to acute hydrocephalus at presentation. Ten percent of operated patients had some form of complication, and 7.7% of operated cases required a shunt at some point during follow-up. Functional outcome was good; however, the need for immediate surgery was associated with educational limitations. Twenty operated cases (20%) experienced a recurrence of their CC at a mean of 38 ± 46 months after the primary surgery. The CC recurrence rate was 24% following endoscopic resection and 15% following open resections (p = 0.28). CONCLUSIONS CCs may present in all pediatric age groups, although most that are symptomatic present after the age of 10 years. Incidentally discovered cysts should be closely followed, as many may grow, leading to hydrocephalus and other new symptoms. Presentation of CC may be acute and may cause life-threatening conditions related to hydrocephalus, necessitating urgent treatment. The outcome of treated children with CCs is favorable.
Collapse
Affiliation(s)
- Jonathan Roth
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and.,2Tel Aviv University, Tel Aviv, Israel
| | - Yurii Perekopaiko
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and
| | - Danil A Kozyrev
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and
| | - Shlomi Constantini
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and.,2Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
7
|
McCrea HJ, Lara-Reyna J, Perera I, Uribe R, Chotai S, Savage N, Hersh EH, Haussner T, Souweidane MM. Colloid cysts of the third ventricle in children. J Neurosurg Pediatr 2021; 27:700-706. [PMID: 33892476 DOI: 10.3171/2020.10.peds18458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/16/2020] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
- Heather J McCrea
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jacques Lara-Reyna
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,5Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Imali Perera
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Rafael Uribe
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Silky Chotai
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,3Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole Savage
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Eliza H Hersh
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Therese Haussner
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Mark M Souweidane
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,4Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York; and
| |
Collapse
|
8
|
Risk Analysis and Management of Third Ventricular Colloid Cysts. World Neurosurg 2020; 146:e1071-e1078. [PMID: 33246179 DOI: 10.1016/j.wneu.2020.11.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Colloid cysts (CCs) are histologically benign lesions that carry the risk of causing obstructive hydrocephalus. The indication for surgery for symptomatic cysts is unquestioned; however, the management of incidentally detected lesions has remained controversial. We independently evaluated the CC risk score (CCRS) as a useful risk stratification scheme. METHODS The demographics, imaging characteristics, and clinical presentations of 103 patients with CC during a 10-year period were correlated with symptoms and the occurrence of hydrocephalus. The discriminate capacity of the CCRS was quantified and a decision algorithm formulated. RESULTS The correlates of symptoms included age <65 years, diameter ≥7 mm, anterior location, hyperintensity on T2-weighted fluid-attenuated inversion recovery (FLAIR) and/or T2-weighted images, and headache at presentation without an alternative explanation. On multivariate analysis, age <65 years, diameter ≥7 mm, and headache at presentation predicted for symptomatic cysts. The CCRS was highly effective at identifying symptomatic patients and those with obstructive hydrocephalus. All patients with cyst growth and symptomatic progression had had an initial CCRS of ≥3 plus hyperintensity (preexisting or developing) on T2-weighted FLAIR images. CONCLUSIONS The CCRS performed exceptionally well in distinguishing the highest risk patients. Closer follow-up is recommended for younger asymptomatic patients with cysts near the foramen of Monro. Hyperintensity on T2-weighted FLAIR images might indicate greater growth potential for small lesions.
Collapse
|
9
|
Pryce ML, Huo CW, Dawes BH, Chung KHC. Giant colloid cyst occupying a cavum septum pellucidum et vergae. J Clin Neurosci 2020; 80:238-241. [PMID: 33099353 DOI: 10.1016/j.jocn.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
Colloid cysts are uncommon, intracranial lesions frequently arising from the anterior aspect of the third ventricle. Rarely a cyst presents greater than 30 mm diameter as a giant colloid cyst. This case reports a patient with a giant colloid cyst occupying a cavum septum pellucidum et vergae. The clinical and operative significance of this anatomical variation is discussed and the giant colloid cyst literature reviewed.
Collapse
Affiliation(s)
- Mitchell L Pryce
- Department of Neurosurgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Cecilia W Huo
- Department of Neurosurgery, The Alfred, 55 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Bryden H Dawes
- Department of Neurosurgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - K H Carlos Chung
- Department of Neurosurgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| |
Collapse
|
10
|
Khanpara SD, Day AL, Bhattacharjee MB, Riascos RF, Fernelius JP, Westmark KD. The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly. AJNR Am J Neuroradiol 2020; 41:1833-1840. [PMID: 32912876 DOI: 10.3174/ajnr.a6722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE While third ventricular colloid cysts may present as an incidental finding, they also harbor the potential to cause ventricular obstruction and sudden death. Herein we analyze the relationship between imaging appearance and the risk of obstructive ventriculomegaly. MATERIALS AND METHODS This is a retrospective review of the MR imaging appearance of 64 patients with colloid cysts, 46 of whom also had a CT scan, obtained by a tertiary hospital imaging report data base search over a 10-year period. Cysts were categorized by appearance on T2-FLAIR and correlated with patient age, cyst size, and the risk of obstructive ventriculomegaly. Histopathologic correlation was available for 28 cases. RESULTS The 64-patient cohort was 52% female, median age 50 years (range 10 to 99 years). Cysts hyperintense on T2-FLAIR (53.1%) were larger (P <.001), occurred in younger patients (P = .01), and had a higher risk of obstructive ventriculomegaly than homogeneously hypointense cysts (relative risk 6.18, 95% CI [2.04, 18.67]). Three patterns of T2 hyperintensity were identified: homogeneously hyperintense, hyperintense rim, and cysts with "dot sign." Although "dot sign" cysts were larger (P < .001), there was no significant difference in patient age or the risk of ventricular obstruction among T2 hyperintense cysts. Cyst wall histopathology did not vary with imaging appearance. CONCLUSIONS Hyperintensity on T2-FLAIR, whether homogeneous, rim, or "dot sign," is associated with larger cyst size and younger patient age, and is an imaging risk factor for obstructive ventriculomegaly. The hyperintense rim does not represent a thickened cyst wall.
Collapse
Affiliation(s)
- S D Khanpara
- Departments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
| | | | - M B Bhattacharjee
- Pathology (M.B.B.), McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - R F Riascos
- Departments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
| | - J P Fernelius
- Department of Quality and Outcomes Management (J.P.F.), Texas Children's Hospital, Houston, Texas
| | - K D Westmark
- Departments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
| |
Collapse
|
11
|
Majmundar N, Ward M, Liu JK. Feasibility and Challenges of Microsurgical Resection of Colloid Cysts in Patients with Preexisting Ventriculoperitoneal Shunts. World Neurosurg 2019; 133:e492-e497. [PMID: 31542439 DOI: 10.1016/j.wneu.2019.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Colloid cysts are the most common third ventricular tumor and may present with symptoms related to obstructive hydrocephalus. Although definitive endoscopic or microsurgical resection is the standard of care, patients may receive temporizing ventriculoperitoneal shunts when definitive management is deferred. Subsequent definitive treatment can be challenging because of the ventricular collapse and narrowing of the operative corridor. There is currently no literature evaluating the feasibility of definitive colloid cyst resection in patients with preexisting ventriculoperitoneal shunts. METHODS We retrospectively reviewed records for patients undergoing colloid cyst resection between 2009 and 2019 to identify patients with preexisting shunts prior to surgery. RESULTS Three patients had preexisting ventriculoperitoneal shunts. Two patients had been shunted at outside institutions where microsurgical or endoscopic resection was not available. One patient received a shunt from an outside surgeon when she was deemed a poor surgical candidate because of cardiac instability. All 3 patients underwent successful gross total colloid cyst resection via the transcallosal approach without recurrences during a mean follow-up of 4.2 years. All patients had intact cognitive and memory function and returned to work. CONCLUSIONS Surgical resection of colloid cysts is possible despite a preexisting ventriculoperitoneal shunt. Because the ventricular space may be collapsed postoperatively because of cerebrospinal fluid diversion, a transcortical route (either endoscopic or microscopic) can be complicated by a small operative corridor with reduced visibility. The transcallosal approach was safe and feasible in these cases for providing midline access with adequate visualization for complete resection despite ventricular collapse.
Collapse
Affiliation(s)
- Neil Majmundar
- Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Max Ward
- Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - James K Liu
- Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
| |
Collapse
|
12
|
Al-Sharydah AM, Al-Suhibani SS, Al-Abdulwahhab AH, Al-Aftan MS, Gashgari AF. A unique finding of cavum velum interpositum colloid-like cyst and literature review of a commonplace lesion in an uncommon place. Int J Gen Med 2018; 11:301-305. [PMID: 30038515 PMCID: PMC6052918 DOI: 10.2147/ijgm.s169018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Colloid cysts typically reside within the area of the anterior third ventricle, in the proximity of the foramen of Monro. Although they are considered to commonly localize in various parts of the cerebrum, they are exceedingly rare outside the ventricular system and rarely occur within the velum interpositum. We have reported here a rare case of a velum interpositum colloid-like cyst in a 23-year-old man, who presented to our clinic with temporary binocular strabismus, which he had been experiencing for the previous year. In addition, we have briefly reviewed evidence regarding the generation, anatomy, and pathogenesis of colloid cysts, as well as the management options for such rare cases. The present report is only the third to describe a colloid-like cyst located within the velum interpositum, providing additional data that may aid in elucidating the pathogenesis of these neoplasms.
Collapse
Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Sari Saleh Al-Suhibani
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Mohammad Saad Al-Aftan
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,
| | - Ahmad Fouad Gashgari
- Diagnostic Radiology Department, Dammam Central Hospital, Dammam, Eastern Province, Saudi Arabia
| |
Collapse
|
13
|
Vazhayil V, Sadashiva N, Nayak N, Prabhuraj AR, Shukla D, Somanna S. Surgical management of colloid cysts in children: experience at a tertiary care center. Childs Nerv Syst 2018; 34:1215-1220. [PMID: 29488075 DOI: 10.1007/s00381-018-3760-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/18/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Colloid cysts are uncommon lesions in the pediatric age group, which most commonly occur in the fourth through fifth decades. The authors hereby report a series of 36 patients with colloid cysts in the pediatric age group. MATERIAL AND METHOD A retrospective chart review was conducted on all patients with colloid cyst who underwent surgery in our institute between November 2003 and December 2016 (13 years). Patients above the age of 18 were excluded from the study. They were analyzed based on clinical presentation, radiological findings, surgical approaches, and outcome. RESULTS There were 36 pediatric patients selected for the study. Age ranged from 8 to 18 years. The male-to-female ratio was 3.5:1. Headache and vomiting were the most common symptoms, and papilledema is the most common clinical sign. The mean duration of symptoms was 9 months (range 1 day to 5 years), but 27 (75%) of the children had precipitous symptoms just before presentation. Preoperative CT showed a hyperdense non-enhancing lesion in the majority of cases. Endoscopic excision was done in 13; 5 patients underwent transcortical transventricular excision, while transcallosal approach was opted for in 17 patients. In one patient, the colloid cyst could not be removed endoscopically and had to be converted to transcortical transventricular approach. Postoperatively, five patients developed CSF leak. They were successfully managed conservatively. One patient had operative site extra dural hematoma and underwent re-exploration, and two patients had transient hemiparesis which improved spontaneously. The median follow-up period was 9 months in the 30 available patients. Though no formal neuropsychological testing was done at follow-up, all children appeared to be doing well without memory disturbances. CONCLUSION Pediatric colloid cysts are less common and may show rapid deterioration. Timely surgery results in a permanent cure with minimum morbidity. The results of either micro neurosurgical or endoscopic operative excision of colloid cysts in children are excellent. All children who are symptomatic with raised intracranial pressure due to a third ventricular colloid cyst should undergo definitive surgery. There were no major permanent deficits in memory or disconnection syndromes observed with the limited anterior colostomy.
Collapse
Affiliation(s)
- Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Nithish Nayak
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - A R Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| |
Collapse
|
14
|
Nelson S, Taylor LP. Headaches in brain tumor patients: primary or secondary? Headache 2016; 54:776-85. [PMID: 24697234 DOI: 10.1111/head.12326] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Headaches occur commonly in all patients, including those who have brain tumors. It has been argued that there is a classic "brain tumor headache type" - defined by the International Headache Society as one that is localized, progressive, worse in the morning, aggravated by coughing or bending forward, develops in temporal and often spatial relation to the neoplasm, and resolves within 7 days of surgical removal or treatment with corticosteroids. METHODS Using the search terms "headache and brain tumors," "intracranial neoplasms and headache," and "facial pain and brain tumors," we reviewed the literature from the past 20 years on brain tumor-associated headache and reflected upon the International Classification of Headache Disorders-3 (ICHD-3). In a separate, complementary paper, the proposed mechanisms of brain tumor headache are reviewed. RESULTS We discuss multiple clinical presentations of brain tumor headaches, present the ICHD-3 diagnostic criteria for each type of headache, and then apply our findings to the ICHD-3. Our primary and major finding was that brain tumor headaches can present similarly to primary headaches in those with a predisposition to headaches, suggesting that following ICHD-3 criteria could cause a clinician to overlook a headache caused by a brain tumor. We further find that some types of headaches are not explicitly discussed in the ICHD-3 and also propose that the International Headache Society formally define SMART (Stroke-like Migraine Attacks after Radiation Therapy) syndrome given the increasing amount of literature on this disorder. CONCLUSION Our literature review revealed that brain tumor headache uncommonly presents with classic brain tumor headache characteristics and often satisfies criteria for a primary headache category such as migraine or tension-type. Thus, clinicians may miss headaches due to brain tumors in following ICHD-3 criteria, and the distinction between primary and secondary headache disorders may not be so clear-cut.
Collapse
Affiliation(s)
- Sarah Nelson
- Departments of Neurology, Tufts Medical Center, Boston, MA, USA
| | | |
Collapse
|
15
|
Lustgarten L. Is there room for stereotactic radiosurgery as an option for third ventricular colloid cysts in patients refusing surgery? A case report and some therapeutic considerations. Surg Neurol Int 2015; 6:S402-5. [PMID: 26500803 PMCID: PMC4596050 DOI: 10.4103/2152-7806.166175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Colloid cysts of the third ventricle are epithelium-lined mucus-filled cysts usually occurring in the anterosuperior third ventricle. They are benign, slow-growing lesions but with the risk of sudden death. Treatment alternatives for symptomatic cysts include stereotactic aspiration, microsurgical or endoscopic approaches, and shunts for hydrocephalus. CASE DESCRIPTION The current case describes a patient presenting with hydrocephalus and a colloid cyst. A ventriculoperitoneal shunt was placed as the patient refused a definitive surgical procedure for the removal of the cyst, and stereotactic radiosurgery was then performed. CONCLUSIONS Stereotactic radiosurgery may be a reasonable alternative with minimal risks in those patients harboring a third ventricle colloid cyst refusing a definitive surgical procedure for resection of the cyst.
Collapse
Affiliation(s)
- Leonardo Lustgarten
- Department of Neurosurgery, Hospital Clinicas Caracas, Caracas, Venezuela
- Department of Radiation Oncology, Hospital Clinicas Caracas, Caracas, Venezuela
- Department of Gammaknife Unit, CDD Las Mercedes, Caracas, Venezuela
| |
Collapse
|
16
|
Filippini A, Prada F, Del Bene M, DiMeco F. Intraoperative cerebral ultrasound for third ventricle colloid cyst removal: case report. J Ultrasound 2014; 19:211-5. [PMID: 27635155 DOI: 10.1007/s40477-014-0151-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the usefulness of intraoperative Ultrasound (ioUS) and Echo-Color-Doppler (ECD) for the surgical removal of a specific deep-sited lesion. METHODS Case report of a woman underwent surgery of a third ventricle colloid cyst removal. RESULTS The ioUS technique depicted the deep intraventricular lesion and all the anatomical structures surrounding the lesion; helping us defining the best trajectory for the safest surgical removal. CONCLUSION In our experience ioUS and ECD have demonstrated to be a reliable and useful intraoperative tool in neurosurgery, not only for superficial tumors but for deep intraventicular lesions as well.
Collapse
Affiliation(s)
- Assunta Filippini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133 Milan, Italy
| | - Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133 Milan, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133 Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133 Milan, Italy
| |
Collapse
|
17
|
Azab WA, Salaheddin W, Alsheikh TM, Nasim K, Nasr MM. Colloid cysts posterior and anterior to the foramen of Monro: Anatomical features and implications for endoscopic excision. Surg Neurol Int 2014; 5:124. [PMID: 25140283 PMCID: PMC4135544 DOI: 10.4103/2152-7806.138364] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background: Colloid cysts are usually located at the rostral part of the third ventricle in proximity to the foramina of Monro. Some third ventricular colloid cysts, however, attain large sizes, reach a very high distance above the roof of the third ventricle, and pose some challenges during endoscopic excision. These features led to the speculation that for such a pattern of growth to take place, the points of origin of these cysts should be at areas away from the foramina of Monro at which some anatomical “windows” exist that are devoid of compact, closely apposed forniceal structures. Methods: A review of the literature on anatomical variations of the structures in the vicinity of the roof of the third ventricle and on reported cases with similar features was conducted. Results: Colloid cysts may grow vertically up past the roof of the third ventricle through anatomical windows devoid of the mechanical restraint of the forniceal structures. Conclusion: Some anatomical variations of the forniceal structures may allow unusually large sizes and superior vector of growth of a retro- or post-foraminal colloid cyst. Careful preoperative planning and knowledge of the pertinent pathoanatomy of these cysts before endoscopic excision is very important to avoid complications.
Collapse
Affiliation(s)
- Waleed A Azab
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | | | - Tarek M Alsheikh
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Khurram Nasim
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Mahmoud M Nasr
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| |
Collapse
|
18
|
Kapu R, Symss NP, Pande A, Vasudevan MC, Ramamurthi R. Management of pediatric colloid cysts of anterior third ventricle: A review of five cases. J Pediatr Neurosci 2012; 7:90-5. [PMID: 23248682 PMCID: PMC3519091 DOI: 10.4103/1817-1745.102563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Object: Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated. Materials and Methods: Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment. Results: Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died 4 hours after the admission. On follow-up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances. Conclusion: Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared with the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
Collapse
Affiliation(s)
- Ravindranath Kapu
- Department of Neurosurgery, Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
19
|
Abstract
The authors present the case of a child with a colloid cyst of the velum interpositum. To the best of the authors' knowledge, this is the first reported case in the pediatric literature and only the second reported case to date. The patient was of an 11-year-old boy in whom this lesion was found after a minor head injury. He had a 6-month history of memory deficits. A lesion consistent with a colloid cyst was seen in the region of the velum interpositum, in the roof of the third ventricle. This lesion was excised successfully via a transcallosal interfornical approach. There were no new postoperative deficits and the child made a full recovery of time.
Collapse
Affiliation(s)
- Tom C Morris
- Department of Neurosurgery, Division of Paediatric Surgery, Women's and Children's Hospital, Adelaide, Australia.
| | | |
Collapse
|
20
|
Ma C, He X, Li Q, Jiang F, Ma J. A rare case of pediatric colloid cysts in bilateral ventricles. Pediatr Neurosurg 2012; 48:371-3. [PMID: 23920281 DOI: 10.1159/000353474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/03/2013] [Indexed: 11/19/2022]
Abstract
Colloid cysts often arise in the third ventricle. It is quite rare for colloid cysts to arise from lateral ventricles. We describe a case of a patient with colloid cysts in the bilateral ventricles. The patient eventually underwent a surgical operation to alleviate the symptoms. Colloid cysts have the potential to be misdiagnosed in the clinical practice; therefore, magnetic resonance imaging and magnetic resonance spectroscopy would be effective for differential diagnosis.
Collapse
Affiliation(s)
- Chenkai Ma
- Department of Pediatric Neurosurgery, Shanghai Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | | | | | | | | |
Collapse
|
21
|
Third ventricular colloid cyst. Pediatr Emerg Care 2011; 27:242-3. [PMID: 21378532 DOI: 10.1097/pec.0b013e31820aa4d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|