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Gurses ME, Lu VM, Gecici NN, Shah KH, Gökalp E, Bashti M, Haider S, Komotar RJ. Utilizing tubular retractors in colloid cyst resection: A single surgeon experience. Surg Neurol Int 2024; 15:179. [PMID: 38840593 PMCID: PMC11152534 DOI: 10.25259/sni_231_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
Background Colloid cysts are intracranial lesions originating from abnormalities in the primitive neuroepithelium folding of the third ventricle. Various surgical approaches have been explored for the management of colloid cysts, each carrying its own set of advantages and limitations. Tubular retractors developed recently alleviate retraction pressure through radial distribution, potentially offering benefits for colloid cyst resection. This study aims to introduce and assess a modified microsurgical method utilizing the tubular retractor for addressing colloid cysts. Methods The study included a retrospective assessment of patients who had colloid cysts and who were treated between 2015 and 2023 by one experienced surgeon. The demographic, clinical, radiological, histological, and surgical data regarding these patients were evaluated. The patients were assessed using the colloid cyst risk score, indicating a risk for obstructive hydrocephalus. Results The minimally invasive microsurgical approach was successfully applied to all 22 identified patients. No postoperative surgical complications were reported. Gross total resection was achieved in 21 (95.5%) patients. The early complication rate was 22.7% (n = 5). There were no postoperative seizures, permanent neurological deficits, or venous injuries. The average hospital stay was 3 days. There was no evidence of recurrence at an average follow-up length of 25.9 months. Conclusion The transtubular approach is an effective, safe method for treating colloid cysts. It achieves complete cyst removal with minimal complications, offering the benefits of less invasiveness, improved visualization, and reduced tissue disruption, strengthening its role in colloid cyst surgery.
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Affiliation(s)
| | - Victor M. Lu
- Department of Neurosurgery, Miami University, Miami, United States
| | | | | | - Elif Gökalp
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Malek Bashti
- Department of Neurosurgery, Miami University, Miami, United States
| | - Sameah Haider
- Department of Neurosurgery, Miami University, Miami, United States
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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.
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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.
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AlSharif M, Stroop R, Scholz M, Buchfelder M, Wiendieck K, Shiban E, Sommer B. Clinical Results and Quality of Life After Transcortical Versus Transcallosal Resection of Adult Lateral and Third Ventricle Lesions: Long-Term Outcome. World Neurosurg 2023; 179:e194-e200. [PMID: 37611805 DOI: 10.1016/j.wneu.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Resection of intraventricular tumors can be achieved using 2 main operative approaches: transcallosal or transcortical. This study aims to describe preoperative and postoperative factors as well as quality of life (QoL) based on long-term results in these patients. METHODS Patients underwent surgery of primary intraventricular lesions between 2007 and 2020 via a transcortical (group A) or transcallosal (group B) route. The main clinical parameters were completeness of resection, overall survival, surgical complications, postoperative neurologic deficits, and seizure rates. QoL was assessed using a modified questionnaire Short-Form 36 inventory. RESULTS Forty patients (19 women and 21 men) met the inclusion criteria. Group A consisted of 26 patients (12 women and 14 men; median age 45.5 years ± 16.7 standard deviation) and had lower preoperative tumor volume (confounder) compared with group B (7 women and 7 men; age 50.0 ± 17.4 years). Gross total resection was achieved in 65% in group A and 71% in group B. Follow-up was 7.8 ± 3.9 years. New seizures/permanent neurologic deficits occurred in 27%/15% (group A) and 29%/29% (group B) and surgical complications in 23% of patients. Group B had a higher degree of memory impairment (21%) compared with group A (10%). QoL impairment was present in both groups mainly regarding physical role function and mental health index. CONCLUSIONS Keeping in mind the limitations, transcallosal surgery was associated with a higher probability of neurologic deficits and memory impairment in our series. However, it had fewer surgical complications with similar gross total resection and seizure rates.
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Affiliation(s)
- Mustafa AlSharif
- Department of Neurosurgery and Spine Surgery, Niels-Stensen-Kliniken Osnabrück, Osnabrüc, Germany; Department of Neurosurgery, Sana Kliniken Duisburg, Duisburg, Germany
| | - Ralf Stroop
- Department of Neurosurgery and Spine Surgery, Niels-Stensen-Kliniken Osnabrück, Osnabrüc, Germany; Faculty of Human Science, Department of Human Medicine, Medical School Hamburg, Hamburg, Germany; Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Martin Scholz
- Department of Neurosurgery, Sana Kliniken Duisburg, Duisburg, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Kurt Wiendieck
- Department of Spine Surgery, Kliniken Dr. Erler GmbH, Nürnberg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Björn Sommer
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany; Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany.
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Sharifi G, Mohammadi E, Jafari A, Mousavinejad SA, Bahranian A, Paraandavaji E, Khosravi YD, Mohammadkhani M. Endoscopic versus Microsurgical Resection of Third Ventricle Colloid Cysts: A Single-Center Case Series of 140 Consecutive Patients. World Neurosurg 2023; 175:e1110-e1116. [PMID: 37116788 DOI: 10.1016/j.wneu.2023.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Both endoscopic and microsurgery transcortical resection methods are used for colloid cysts of the third ventricle but they have not been compared regarding benefits and pitfalls. METHODS Data of patients who underwent surgical resection of third ventricle colloid cyst via either endoscopic or microsurgery approach by a single surgeon from 2005 to 2020 were retrospectively collected. After administration of criteria, 140 records were retrieved (60 patients through endoscopic resection and 80 patients by a transcranial microsurgery approach). Clinical and surgical measures were compared between the 2 types of surgery after adjustment for confounders. RESULTS Length of hospital stay, postoperative meningitis, operation time, cyst size, and baseline comorbidities were similar between two groups. Gross total resection (GTR) was achieved for all patients in the microsurgery group, whereas in the endoscopic group, resection was lower (90% vs. 100%; P = 0.005). Intraoperative hemorrhage occurred in 14 endoscopic patients (23.3%), whereas for the microscopic group, it was zero (P < 0.001). Postoperative shunt was required for 2 patients (one in the endoscopic group and the other in the microscopic group). Two patients had tumor recurrence, both of whom were in the endoscopic group. No mortality was detected in either group. Multivariate analyses were insignificant for confounding effects of clinical and demographic factors in occurrence of worse surgical outcomes (non-GTR and hemorrhage). CONCLUSIONS In our series, the rate of intraoperative hemorrhage was higher with the endoscopic method and GTR was lower, even after adjustment for other factors. This situation could be caused by technological shortcomings and limited space for resection maneuvers and management of complications.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran; Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, USA.
| | - Ali Jafari
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran; Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Seyed Ali Mousavinejad
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran; Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Arefeh Bahranian
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Elham Paraandavaji
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | | | - Maryam Mohammadkhani
- Department of Neurosurgery, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
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Paolini S, Severino R, Ciavarro M, Missori P, Cardarelli G, Mancarella C. Balloon-Assisted Corpus Callosotomy. Reducing the Impact of Transcallosal Approaches. Oper Neurosurg (Hagerstown) 2023; 24:e155-e159. [PMID: 36701680 DOI: 10.1227/ons.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/12/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The interhemispheric transcallosal approach is widely used to remove intraventricular lesions. Corpus callosotomy gives immediate access to the ventricular chambers but is invasive in nature. Loss of callosal fibers, although normally tolerate, may cause disturbances ranging from a classical disconnection syndrome up to minor neuropsychological changes. OBJECTIVE To open an operative window in the corpus callosum through separation rather than disconnection of the white matter fibers. METHODS In 7 patients undergoing the interhemispheric transcallosal approach for intraventricular lesions, lying around or below the foramen of Monro, a stoma was created within the corpus callosum by using a 4F Fogarty catheter. The series included 3 colloid of the third ventricle, 2 thalamic cavernomas, 1 subependymoma, and 1 ependymoma of the foramen of Monro. We illustrate the technique and the clinico-radiological outcome, focusing on the size of callosotomy as seen on postoperative MRI. RESULTS The balloon-assisted corpus callosotomy provided a circular, smooth-walled access to the ventricular chambers, which allowed uncomplicated removal of the lesions. On postoperative MRI, the size of the callosotomy shrinked compared with surgery (2.8-6.4 mm at follow-up vs 6-9 mm as measured intraoperatively). No signs of disconnection syndrome or new permanent deficits were observed in this series. CONCLUSION The balloon-assisted technique produces a small callosotomy, without clinical consequences, showing a self-closing trend on postoperative MRI. This technique is a rewarding tool to reduce the impact of callosotomy while keeping the advantages of microsurgical interhemispheric approaches.
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Affiliation(s)
- Sergio Paolini
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Rocco Severino
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Marco Ciavarro
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Giovanni Cardarelli
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Cristina Mancarella
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
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Velicu MA, Rossmann K, Vahedi A, Lavrador JP, Vergani F, Bhangoo R, Gullan R, Booth T, Ashkan K. On Natural History and Management of Colloid Cysts: Time to Rethink? World Neurosurg 2023; 170:e188-e199. [PMID: 36323347 DOI: 10.1016/j.wneu.2022.10.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Colloid cysts, although benign, may occasionally cause obstructive hydrocephalus and sudden death. Reliable prognostic factors for symptomatic progression have been sought, with heterogenous results. METHODS We conducted a retrospective review of all cases of colloid cysts of the third ventricle managed at our center between 2009 and 2019. Clinical and neuroimaging characteristics were analyzed using logistic regression in relation to symptomatic status and hydrocephalus. The cutoff values for outcome prediction were calculated using the receiver operating characteristic curve analysis. RESULTS There were 82 patients with colloid cysts, of whom 60 were asymptomatic and 22 symptomatic. None of the asymptomatic patients experienced acute neurologic decline or hydrocephalus during follow-up, whereas half (n = 11) of the symptomatic patients presented with hydrocephalus, 8 of whom had acute hydrocephalus. We found 3 putative candidate risk factors for symptomatic colloid cysts: T1-weighted magnetic resonance imaging hyperintense/mixed signal appearance (P = 0.004), location in risk zone I (P = 0.007), and a volume >236.49 mm3 (P = 0.007). Cyst diameter and volume/foramen of Monro diameter ratios had a decreasing trend over time among asymptomatic patients, providing new insights into the natural history of the disease. CONCLUSIONS Only a few asymptomatic colloid cysts showed progression requiring surgery, with no acute deterioration or fatal events, whereas the rest remained stable over time, thus supporting a more conservative approach for this group of patients. Higher risk for developing symptomatic colloid cyst was defined by a risk score that included T1-weighted magnetic resonance imaging appearance, risk zone, and colloid cyst volume, aiding the detection of patients at risk of clinical deterioration.
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Affiliation(s)
- Maria Alexandra Velicu
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Kristin Rossmann
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ali Vahedi
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, King's Health Partners Academic Health Sciences Centre, London, United Kingdom
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Booth
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, King's Health Partners Academic Health Sciences Centre, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Beaumont TL, Limbrick DD, Patel B, Chicoine MR, Rich KM, Dacey RG. Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection. J Neurosurg 2022; 137:905-913. [PMID: 35148502 DOI: 10.3171/2021.11.jns211317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Colloid cysts of the third ventricle are histologically benign lesions that can cause obstructive hydrocephalus and death. Historically, colloid cysts have been removed by open microsurgical approaches. More recently, minimally invasive endoscopic and port-based techniques have offered decreased complications and length of stay, with improved patient satisfaction. METHODS A single-center retrospective analysis of patients with colloid cysts who underwent surgery at a large tertiary care hospital was performed. The cohort was assessed based on the surgical approach, comparing endoscopic resection to open microsurgical resection. The primary endpoint was rate of perioperative complications. Univariate analysis was used to assess several procedure-related variables and the cost of treatment. Multivariate analysis was used to assess predictors of perioperative complications. Total inpatient cost for each case was extracted from the health system financial database. RESULTS The study included 78 patients with colloid cysts who underwent resection either via an endoscopic approach (n = 33) or through a craniotomy (n = 45) with an interhemispheric-transcallosal or transcortical-transventricular approach. Nearly all patients were symptomatic, and half had obstructive hydrocephalus. Endoscopic resection was associated with reduced operative time (3.2 vs 4.9 hours, p < 0.001); lower complication rate (6.1% vs 33.1%, p = 0.009); reduced length of stay (4.1 vs 8.9 days, p < 0.001); and improved discharge to home (100% vs 75.6%, p = 0.008) compared to microsurgical resection. Coagulated residual cyst wall remnants were more common after endoscopic resection (63.6% vs 19.0%, p < 0.001) although this was not associated with a significantly increased rate of reoperation for recurrence. The mean follow-up was longer in the microsurgical resection group (3.1 vs 4.9 years, p = 0.016). The total inpatient cost of endoscopic resection was, on average, one-half (47%) that of microsurgical resection. When complications were encountered, the total inpatient cost of microsurgical resection was 4 times greater than that of endoscopic resection where no major complications were observed. The increased cost-effectiveness of endoscopic resection remained during reoperation. CONCLUSIONS Endoscopic resection of colloid cysts of the third ventricle offers a significant reduction in perioperative complications when compared to microsurgical resection. Endoscopic resection optimizes nearly all procedure-related variables compared to microsurgical resection, and reduces total inpatient cost by > 50%. However, endoscopic resection is associated with a significantly increased likelihood of residual coagulated cyst wall remnants that could increase the rate of reoperation for recurrence. Taken together, endoscopic resection represents a safe and effective minimally invasive approach for removal of colloid cysts.
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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.
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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
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Comparison of microscopic and endoscopic resection of third-ventricular colloid cysts: A Systematic Review and Meta-Analysis. Clin Neurol Neurosurg 2022; 215:107179. [DOI: 10.1016/j.clineuro.2022.107179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/15/2023]
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10
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Alkhaibary A, Baydhi L, Alharbi A, Alshaikh AA, Khairy S, Abbas M, Abdelkhalek Aboushady AM, Almuntashri M, Alassiri AH, Alkhani A, Alferayan AA, Aloraidi A. Endoscopic versus Open Microsurgical Excision of Colloid Cysts: A Comparative Analysis and State-of-the-Art Review of Neurosurgical Techniques. World Neurosurg 2021; 149:e298-e308. [PMID: 33601083 DOI: 10.1016/j.wneu.2021.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The surgical approaches of colloid cysts commonly include endoscopy or open microsurgery. Each approach carries its own challenges, feasibility, and complications. The aim of the current study is to compare endoscopic versus open microsurgical excision of third ventricular colloid cysts. METHODS A retrospective cohort study was conducted to compare the surgical outcomes of endoscopic versus open microsurgical (transcortical-transventricular and transcallosal approaches) excision of colloid cyst of the third ventricle at a tertiary-care medical institute. All patients with a neuroradiologic diagnosis of colloid cyst who subsequently underwent surgical management between January 2003 and June 2020 were included. The neurologic outcome was assessed at the last follow-up visit. RESULTS A total of 32 patients with colloid cysts were included in the study. The mean age was 35.8 ± 18.3 years (range, 4-75 years). Female patients slightly outnumbered male patients (n = 17; 53.1%). A total of 21 patients (65.6%) underwent endoscopic resection of the colloid cyst. Complications were encountered in 7 patients (endoscopic, n = 3; microsurgery, n = 4; P = 0.151). Recurrence was identified in 4 patients (endoscopic, n = 3; microsurgery, n = 1; P = 0.673). Most patients improved neurologically on follow-up visits to the clinic (endoscopic, n = 19; microsurgery, n = 9; P = 0.482). CONCLUSIONS Both endoscopic and microsurgical approaches provide favorable surgical outcomes in colloid cyst resection. The complication rates between both approaches is statistically insignificant. The optimal surgical approach for colloid cyst resection remains controversial.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Laila Baydhi
- College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahoud Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Aljoharah A Alshaikh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Munzir Abbas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | | | - Makki Almuntashri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ali H Alassiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | | | - Ahmed Aloraidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Elshamy W, Burkard J, Gerges M, Erginoglu U, Aycan A, Ozaydin B, Dempsey RJ, Baskaya MK. Surgical approaches for resection of third ventricle colloid cysts: meta-analysis. Neurosurg Rev 2021; 44:3029-3038. [PMID: 33590366 DOI: 10.1007/s10143-021-01486-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
Although outcome studies and systematic reviews have been published on the surgical treatment of third ventricle colloid cysts (TVCC), there are no meta-analyses that compare the outcomes for various surgical approaches. This meta-analysis assesses the outcomes and complications for transcortical, transcallosal, and endoscopic surgical approaches used to excise TVCCs. A meta-analysis of surgically excised TVCCs was performed with an assessment of outcome for transcortical, transcallosal, and endoscopic approaches. A random-effects model analyzed the extent of surgical excision. The analysis included reports that compared at least two of these surgical approaches, for a total of 11 studies comprising a population of 301 patients. The transcortical approach was associated with a higher incidence of complete excision compared to the endoscopic approach (OR = 0.137, p = 0.041), with no significant differences observed between transcortical and transcallosal approaches, and between transcallosal and endoscopic approaches. Comparison between endoscopic and pooled microsurgical approaches was also insignificant (OR = 0.22, p = 1). The risk of motor weakness was increased with the transcortical approach compared to the endoscopic approach (OR = 6.10, p = 0.018). There were no significant differences between transcortical and transcallosal approaches regarding newly onset seizures, and no significant mortality differences between all three approaches. This study demonstrates that microsurgical approaches are associated with a greater extent of resection compared to endoscopic approaches; however, best results are likely achieved based on the surgeon's expertise, flexibility, and case review.
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Affiliation(s)
- Walid Elshamy
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA.,Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jake Burkard
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Mina Gerges
- Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ufuk Erginoglu
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Abdurahman Aycan
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Burak Ozaydin
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA.
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Alford EN, Rotman LE, Lepard JR, Agee BS, Markert JM. Interrater and Intrarater Reliability of the Colloid Cyst Risk Score. Neurosurgery 2020; 86:E47-E53. [PMID: 31552408 DOI: 10.1093/neuros/nyz399] [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: 12/13/2018] [Accepted: 07/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Colloid Cyst Risk Score (CCRS) was developed to identify symptomatic patients and stratify risk of hydrocephalus among patients with colloid cysts. Its components consider patient age, cyst diameter, presence/absence of headache, fluid-attenuated inversion recovery (FLAIR) hyperintensity, and location within the third ventricle. OBJECTIVE To independently evaluate the inter- and intrarater reliability of the CCRS. METHODS Patients with a colloid cyst were identified from billing records and radiology archives. Three independent raters reviewed electronic medical records to determine age, presence/absence of headache, cyst diameter (mm), FLAIR hyperintensity, and risk zone location. Raters made 53 observations, including 5 repeat observations.Fleiss' generalized kappa (κ) was calculated for all of the nominal criteria, whereas Kendall's coefficient of concordance (W) and the intraclass correlation coefficient (ICC) were calculated for the overall score. RESULTS Total CCRS score demonstrated extremely strong agreement (W = 0.83) using Kendall's W coefficient and good agreement (ICC = 0.74) using the ICC (P < .001). For interrater reliability of individual criteria, age (κ = 1.00) and FLAIR hyperintensity (κ = 0.89) demonstrated near perfect agreement. Axial diameter (κ = 0.63) demonstrated substantial agreement, whereas agreement was moderate for risk zone (κ = 0.51) and fair for headache (κ = 0.26). Intrarater reliability for total CCRS score was extremely strong using Kendall's W, good to excellent using ICC, and fair to substantial using weighted kappa. CONCLUSION The CCRS has good inter- and intrarater reliability when tested in an independent sample of patients, though strength of agreement varies among individual criteria. The validity of the CCRS requires independent evaluation.
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Affiliation(s)
- Elizabeth N Alford
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lauren E Rotman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jacob R Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bonita S Agee
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Isaacs AM, Bezchlibnyk YB, Dronyk J, Urbaneja G, Yong H, Hamilton MG. Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System. Oper Neurosurg (Hagerstown) 2020; 19:134-142. [DOI: 10.1093/ons/opz409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Endoscopic resection of colloid cysts has gained recent widespread practice. However, reported complication and recurrence rates are variable, possibly, in part, because of a lack of consistency with reporting of the extent of cyst capsule removal.
OBJECTIVE
To present the long-term outcomes of endoscopic resection of third ventricle colloid cysts without complete capsule removal and propose a grading system to allow consistent description of surgical outcomes.
METHODS
A retrospective review of 74 patients who underwent endoscopic resection of symptomatic third ventricle colloid cysts between 1995 and 2018 was performed. Kaplan-Meier analyses were used to assess recurrence-free survival rates.
RESULTS
Median patient age and cyst diameter were 48.0 (13.0-80.0) yr and 12.0 (5.0-27.0) mm, respectively. Complete emptying of cyst contents with capsule coagulation was achieved in 73 (98.6%) patients. All patients improved or remained stable postoperatively, with a median follow-up duration of 10.3 (0.3-23.7) yr. Radiographic recurrence occurred in 6 (8.1%) patients after their initial surgery, 5 (6.8%) of whom underwent redo endoscopic resection. No major complications or mortality was encountered at primary or recurrence surgery.
CONCLUSION
Endoscopic resection of third ventricle colloid cysts without emphasizing complete capsule removal is a viable option for successfully treating colloid cysts of the third ventricle. Long-term follow-up demonstrates that it is associated with low risks of complications, morbidity, mortality, and recurrence. The proposed extent of the resection grading scheme will permit comparison between the different surgical approaches and facilitate the establishment of treatment guidelines for colloid cysts.
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Affiliation(s)
- Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Jarred Dronyk
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Geberth Urbaneja
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Heather Yong
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark G Hamilton
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
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14
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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.
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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.
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Endoscopic Versus Microscopic Transcallosal Excision of Colloid Cysts: A Systematic Review in the Era of Complete Endoscopic Excision. World Neurosurg 2019; 132:e53-e58. [PMID: 31518748 DOI: 10.1016/j.wneu.2019.08.259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Transcallosal microscopic and endoscopic excisions are both well established approaches to colloid cyst resection; however, there has been no clear consensus regarding the favored approach. We performed a systematic review comparing the transcallosal microscopic and endoscopic transcortical approaches for colloid cyst excision. METHODS We performed a systematic review from 2000-2018 of patients undergoing colloid cyst excision via a microscopic transcallosal or endoscopic transcortical approach where the surgical intent was gross total resection. Studies that included multiple approaches were included if the reported results were stratified by approach. RESULTS The microsurgical transcallosal approach had a higher rate of gross total resection when compared with endoscopic excision (96% for transcallosal vs. 78.5% endoscopic; P < 0.0001). There was also a lower recurrence rate with the transcallosal approach (0.98% vs. 2.16%; P = 0.0036); however, there was no difference in reoperation rates with similar length of follow-up (0.33% transcallosal, 0.61% endoscopic; P = 1.000). Endoscopy had lower overall morbidity when compared with transcallosal approaches (8.7% vs. 18.6%; P = 0.0001), including statistically significant lower rates of infection, infarct, and seizures in the endoscopic cohort. Rates of permanent memory deficit were similar (6.55% transcallosal vs. 4.5% endoscopic; P = 0.52). Shunt dependency was 9.8% after transcallosal excision versus 3.5% after endoscopic excision (P = 0.0002). CONCLUSIONS Modern series of colloid cyst excision continue to favor transcallosal approaches in achieving gross total resection. Nevertheless, endoscopic techniques have significantly reduced morbidity compared to transcallosal approaches, including lower rates of infection, infarct, and seizure. Endoscopic approaches also have a statistically significant decreased rate of shunt dependency-arguably the most important primary endpoint of surgery. With improving endoscopic technology and mastery of the technique, endoscopic excision is maturing into a standard first-line approach for colloid cyst excision.
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16
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The Impact of Colloid Cyst Treatment on Neurocognition. World Neurosurg 2019; 125:e372-e377. [DOI: 10.1016/j.wneu.2019.01.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 11/15/2022]
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Azab WA, Abdelnabi EA, Mostafa KH. Efficacy and Safety of the Rotational Technique for Endoscopic Transforaminal Excision of Colloid Cysts of the Third Ventricle. World Neurosurg 2019; 125:e602-e611. [DOI: 10.1016/j.wneu.2019.01.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Chakravarthi SS, Kassam AB, Fukui MB, Monroy-Sosa A, Rothong N, Cunningham J, Jennings JE, Guenther N, Connelly J, Kaemmerer T, Nash KC, Lindsay M, Rissell J, Celix JM, Rovin RA. Awake Surgical Management of Third Ventricular Tumors: A Preliminary Safety, Feasibility, and Clinical Applications Study. Oper Neurosurg (Hagerstown) 2019; 17:208-226. [DOI: 10.1093/ons/opy405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 02/07/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUNDEndoscopic and microneurosurgical approaches to third ventricular lesions are commonly performed under general anesthesia.OBJECTIVETo report our initial experience with awake transsulcal parafascicular corridor surgery (TPCS) of the third ventricle and its safety, feasibility, and limitations.METHODSA total of 12 cases are reviewed: 6 colloid cysts, 2 central neurocytomas, 1 papillary craniopharyngioma, 1 basal ganglia glioblastoma, 1 thalamic glioblastoma, and 1 ependymal cyst. Lesions were approached using TPCS through the superior frontal sulcus. Pre-, intra-, and postoperative neurocognitive (NC) testing were performed on all patients.RESULTSNo cases required conversion to general anesthesia. Awake anesthesia changed intraoperative management in 4/12 cases with intraoperative cognitive changes that required port re-positioning; 3/4 recovered. Average length of stay (LOS) was 6.1 d ± 6.6. Excluding 3 outliers who had preoperative NC impairment, the average LOS was 2.5 d ± 1.2. Average operative time was 3.00 h ± 0.44. Average awake anesthesia time was 5.05 h ± 0.54. There were no mortalities.CONCLUSIONThis report demonstrated the feasibility and safety of awake third ventricular surgery, and was not limited by pathology, size, or vascularity. The most significant factor impacting LOS was preoperative NC deficit. The most significant risk factor predicting a permanent NC deficit was preoperative 2/3 domain impairment combined with radiologic evidence of invasion of limbic structures – defined as a “NC resilience/reserve” in our surgical algorithm. Larger efficacy studies will be required to demonstrate the validity of the algorithm and impact on long-term cognitive outcomes, as well as generalizability of awake TPCS for third ventricular surgery.
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Affiliation(s)
- Srikant S Chakravarthi
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Amin B Kassam
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Melanie B Fukui
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Alejandro Monroy-Sosa
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Nichelle Rothong
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Joseph Cunningham
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Jonathan E Jennings
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Neil Guenther
- Department of Anesthesiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Jeremy Connelly
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Tobias Kaemmerer
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Kenneth C Nash
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Janie Rissell
- Department of Neuropsychology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Juanita M Celix
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Richard A Rovin
- Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
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Vorbau C, Baldauf J, Oertel J, Gaab MR, Schroeder HW. Long-Term Results After Endoscopic Resection of Colloid Cysts. World Neurosurg 2019; 122:e176-e185. [DOI: 10.1016/j.wneu.2018.09.190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
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Bozkurt B, Yağmurlu K, Belykh E, Tayebi Meybodi A, Staren MS, Aklinski JL, Preul MC, Grande AW, Nakaji P, Lawton MT. Quantitative Anatomic Analysis of the Transcallosal-Transchoroidal Approach and the Transcallosal-Subchoroidal Approach to the Floor of the Third Ventricle: An Anatomic Study. World Neurosurg 2018; 118:219-229. [PMID: 30010067 DOI: 10.1016/j.wneu.2018.05.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare transcallosal-transchoroidal and transcallosal-subchoroidal approaches to the ipsilateral and contralateral edges of the floor of the third ventricle using quantitative analyses. METHODS Five formalin-fixed cadaveric human heads (10 sides) were examined under the operating microscope. Quantitative measurements (area of surgical freedom and angle of attack) were obtained using 3-T magnetic resonance imaging and a StealthStation image guidance system. The limits of the surgical approaches were shown by touching a probe to 6 designated points on the floor of the third ventricle. RESULTS The transchoroidal approach provided greater surgical freedom than the subchoroidal approach to access ipsilateral and contralateral middle landmarks at the edges of the floor of the third ventricle in both longitudinal and horizontal planes (P ≤ 0.03). No significant difference between the 2 approaches was found in accessing the anterior and posterior landmarks of the third ventricle in each plane. The surgical freedom to the contralateral anterior, middle, and posterior landmarks was greater than to the ipsilateral landmarks in both the transchoroidal and subchoroidal approaches. CONCLUSIONS The transcallosal-transchoroidal approach, compared with the transcallosal-subchoroidal approach, may provide better exposure and require less retraction for removal of ipsilateral or contralateral lesions located in the midbrain or hypothalamus and situated near the floor of the third ventricle. The contralateral transcallosal approach with either the transchoroidal or subchoroidal approach may provide good surgical freedom for removal of lesions located near the floor of the third ventricle, such as lesions in the midbrain.
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Affiliation(s)
- Baran Bozkurt
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kaan Yağmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael S Staren
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph L Aklinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Factors influencing outcome in patients with colloid cysts who present with acute neurological deterioration. J Clin Neurosci 2018; 54:88-95. [DOI: 10.1016/j.jocn.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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Connolly ID, Johnson E, Lamsam L, Veeravagu A, Ratliff J, Li G. Microsurgical vs. Endoscopic Excision of Colloid Cysts: An Analysis of Complications and Costs Using a Longitudinal Administrative Database. Front Neurol 2017; 8:259. [PMID: 28649225 PMCID: PMC5465269 DOI: 10.3389/fneur.2017.00259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Open microsurgical and endoscopic approaches are the two main surgical options for excision of colloid cysts. Controversy remains as to which is superior. Previous studies consist of small cohort sizes. This topic has not been investigated using national administrative claims data which benefits from larger patient numbers. METHODS Current Procedural Terminology (CPT) and International Classification of Disease version 9 (ICD-9) coding at inpatient visit was used to select for index surgical procedures corresponding to microsurgical or endoscopic excision of colloid cysts. Comorbidities, costs, and complications were collected. RESULTS We identified a total of 483 patients. In all, 240 were from the microsurgical cohort and 243 were from the endoscopic cohort. The two groups displayed similar demographic and comorbidity profiles. Thirty-day post-operative complications were also similar between groups with the exception of seizures and thirty-day readmissions, both higher in the open surgical cohort. The seizure rates were 14.7 and 5.4% in the microsurgical and endoscopic cohorts, respectively (p = 0.0011). The thirty-day readmission rates were 17.3 and 9.6% in the microsurgical and endoscopic cohorts, respectively (p = 0.0149). Index admission costs and 90-day post discharge payments were higher in patients receiving microsurgical excision. CONCLUSION An analysis of administrative claims data revealed few differences in surgical complications following colloid cyst excision via microsurgical and endoscopic approaches. Post-operative seizures and thirty-day readmissions were seen at higher frequency in patients who underwent microsurgical resection. Despite similar complication profiles, patients undergoing microsurgical excision experienced higher index admission costs and 90-day aggregated costs suggesting that complications may have been more severe in this group.
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Affiliation(s)
- Ian David Connolly
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Layton Lamsam
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
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Beaumont TL, Limbrick DD, Rich KM, Wippold FJ, Dacey RG. Natural history of colloid cysts of the third ventricle. J Neurosurg 2016; 125:1420-1430. [PMID: 26967781 DOI: 10.3171/2015.11.jns151396] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-prediction model was defined using bootstrapped logistic regression. Predictive factors were then combined into a simple 5-point clinical scale referred to as the Colloid Cyst Risk Score (CCRS), and this was evaluated with receiver-operator characteristics. RESULTS The study included 163 colloid cysts, more than half of which were discovered incidentally. More than half of the incidental cysts (58%) were followed with surveillance neuroimaging (mean follow-up 5.1 years). Five patients with incidental cysts (8.8%) progressed and underwent resection. No patient with an incidental, asymptomatic colloid cyst experienced acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly half (46.2%) of symptomatic patients presented with hydrocephalus. Eight patients (12.3%) presented acutely, and there were 2 deaths due to obstructive hydrocephalus and herniation. The authors identified several factors that were strongly correlated with the 2 outcome variables and defined third ventricle risk zones where colloid cysts can cause obstructive hydrocephalus. No patient with a lesion outside these risk zones presented with obstructive hydrocephalus. The CCRS had significant predictive capacity for symptomatic clinical status (area under the curve [AUC] 0.917) and obstructive hydrocephalus (AUC 0.845). A CCRS ≥ 4 was significantly associated with obstructive hydrocephalus (p < 0.0001, RR 19.4). CONCLUSIONS Patients with incidentally discovered colloid cysts can experience both lesion enlargement and symptom progression or less commonly, contraction and symptom regression. Incidental lesions rarely cause acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly one-half of patients with symptomatic colloid cysts present with obstructive hydrocephalus, which has an associated 3.1% risk of death. The CCRS is a simple 5-point clinical tool that can be used to identify symptomatic lesions and stratify the risk of obstructive hydrocephalus. External validation of the CCRS will be necessary before objective surgical indications can be established. Surgical intervention should be considered for all patients with CCRS ≥ 4, as they represent the high-risk subgroup.
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Affiliation(s)
| | | | | | - Franz J Wippold
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Sharifi G, Bakhtevari MH, Samadian M, Alavi E, Rezaei O. Endoscopic Surgery in Nonhydrocephalous Third Ventricular Colloid Cysts: A Feasibility Study. World Neurosurg 2015; 84:398-404. [PMID: 25827046 DOI: 10.1016/j.wneu.2015.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly. METHODS Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients' outcome were assessed and compared with another 53 patients with hydrocephalus who underwent similar procedures. Our study was performed in a retrospective basis, although in middle of our work we decided to study and follow nonhydrocephalus cases prospectively. RESULTS The ventricular compartments were successfully cannulated and gross total resection and near total resection of the colloid cysts was achieved in all patients. There were no persistent operative complications related to the endoscopic procedure. The success rate for endoscopic surgery in patients without hydrocephalus was similar to its value in patients with hydrocephalus. CONCLUSIONS Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Samadian
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Alavi
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Osorio JA, Clark AJ, Safaee M, Tate MC, Aghi MK, Parsa A, McDermott MW. Intraoperative Conversion from Endoscopic to Open Transcortical-Transventricular Removal of Colloid Cysts as a Salvage Procedure. Cureus 2015; 7:e247. [PMID: 26180671 PMCID: PMC4494539 DOI: 10.7759/cureus.247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the transcortical-transventricular as an intraoperative salvage procedure and its effect of operative time and outcome. METHODS Thirty-three patients were included in the study. Twenty patients had an endoscopic operation, five had a transcortical-transventricular approach, and eight underwent an interhemispheric approach for resection. Based on common cyst location in the roof of the third ventricle, we propose a simple classification of surgical operative zones based on relationships defined by the anterior column of the fornix, the septal vein, and the medial atrial vein. RESULTS Complete capsule removal was achieved in 35% of endoscopic operations, 100% of transcortical-transventricular operations, and 63% of the interhemispheric operations. Operative time was 176 minutes for endoscopic operations, whereas the operative time for cases that converted to the transcortical-transventricular approach was 190 minutes (p=0.39). CONCLUSION A surgical-based classification of zones within the roof of the third ventricle that can be accessed with microsurgical techniques is proposed. Both endoscopic and microsurgical cyst aspiration and excision remain options. We believe that younger patients, patients with large cysts that fill the third ventricle, or those with recurrence after prior treatment would benefit from open transcortical excision as a safe and effective operative approach using modern image-guided systems. Consent was formally obtained or waived for all subjects present within this study.
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Affiliation(s)
- Joseph A Osorio
- Department of Neurological Surgery, University of California, San Francisco
| | - Aaron J Clark
- Department of Neurological Surgery, University of California, San Francisco
| | - Michael Safaee
- Department of Neurological Surgery, University of California, San Francisco
| | - Matthew C Tate
- Neurological Surgery, Northwestern University Feinberg School of Medicine
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco
| | - Andrew Parsa
- Department of Neurological Surgery, University of California, San Francisco
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Endoscopic Versus Microsurgical Resection of Colloid Cysts: A Systematic Review and Meta-Analysis of 1278 Patients. World Neurosurg 2014; 82:1187-97. [DOI: 10.1016/j.wneu.2014.06.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/11/2014] [Indexed: 11/18/2022]
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Rangel-Castilla L, Chen F, Choi L, Clark JC, Nakaji P. Endoscopic approach to colloid cyst: what is the optimal entry point and trajectory? J Neurosurg 2014; 121:790-6. [DOI: 10.3171/2014.5.jns132031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
An optimal entry point and trajectory for endoscopic colloid cyst (ECC) resection helps to protect important neurovascular structures. There is a large discrepancy in the entry point and trajectory in the neuroendoscopic literature.
Methods
Trajectory views from MRI or CT scans used for cranial image guidance in 39 patients who had undergone ECC resection between July 2004 and July 2010 were retrospectively evaluated. A target point of the colloid cyst was extended out to the scalp through a trajectory carefully observed in a 3D model to ensure that important anatomical structures were not violated. The relation of the entry point to the midline and coronal sutures was established. Entry point and trajectory were correlated with the ventricular size.
Results
The optimal entry point was situated 42.3 ± 11.7 mm away from the sagittal suture, ranging from 19.1 to 66.9 mm (median 41.4 mm) and 46.9 ± 5.7 mm anterior to the coronal suture, ranging from 36.4 to 60.5 mm (median 45.9 mm). The distance from the entry point to the target on the colloid cyst varied from 56.5 to 78.0 mm, with a mean value of 67.9 ± 4.8 mm (median 68.5 mm). Approximately 90% of the optimal entry points are located 40–60 mm in front of the coronal suture, whereas their perpendicular distance from the midline ranges from 19.1 to 66.9 mm. The location of the “ideal” entry points changes laterally from the midline as the ventricles change in size.
Conclusions
The results suggest that the optimal entry for ECC excision be located at 42.3 ± 11.7 mm perpendicular to the midline, and 46.9 ± 5.7 mm anterior to the coronal suture, but also that this point differs with the size of the ventricles. Intraoperative stereotactic navigation should be considered for all ECC procedures whenever it is available. The entry point should be estimated from the patient's own preoperative imaging studies if intraoperative neuronavigation is not available. An estimated entry point of 4 cm perpendicular to the midline and 4.5 cm anterior to the coronal suture is an acceptable alternative that can be used in patients with ventriculomegaly.
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Affiliation(s)
- Leonardo Rangel-Castilla
- 1Division of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Fangxiang Chen
- 2Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Lawrence Choi
- 1Division of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Justin C. Clark
- 1Division of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Peter Nakaji
- 1Division of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Sribnick EA, Dadashev VY, Miller BA, Hawkins S, Hadjipanayis CG. Neuroendoscopic Colloid Cyst Resection: A Case Cohort with Follow-Up and Patient Satisfaction. World Neurosurg 2014; 81:584-93. [DOI: 10.1016/j.wneu.2013.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/23/2013] [Accepted: 12/07/2013] [Indexed: 11/17/2022]
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Wilson DA, Fusco DJ, Wait SD, Nakaji P. Endoscopic Resection of Colloid Cysts: Use of a Dual-Instrument Technique and an Anterolateral Approach. World Neurosurg 2013; 80:576-83. [PMID: 22850283 DOI: 10.1016/j.wneu.2012.07.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/16/2012] [Accepted: 07/25/2012] [Indexed: 11/16/2022]
Affiliation(s)
- David A Wilson
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Barber SM, Rangel-Castilla L, Baskin D. Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis. Minim Invasive Surg 2013; 2013:898753. [PMID: 24191196 PMCID: PMC3804403 DOI: 10.1155/2013/898753] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/08/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a systematic review of the literature to provide a better understanding of the virtues and limitations of endoscopic tumor resection. Materials and Methods. 40 articles describing 668 endoscopic tumor resections were selected from the Pubmed database and reviewed. Results. Complete or near-complete resection was achieved in 75.0% of the patients. 9.9% of resected tumors recurred during the follow-up period, and procedure-related complications occurred in 20.8% of the procedures. Tumor size ≤ 2cm (P = 0.00146), the presence of a cystic tumor component (P < 0.0001), and the use of navigation or stereotactic tools during the procedure (P = 0.0003) were each independently associated with a greater likelihood of complete or near-complete tumor resection. Additionally, the complication rate was significantly higher for noncystic masses than for cystic ones (P < 0.0001). Discussion. Neuroendoscopic outcomes for intraventricular tumor resection are significantly better when performed on small, cystic tumors and when neural navigation or stereotaxy is used. Conclusion. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors of a particular morphology.
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Affiliation(s)
- Sean M. Barber
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
| | - Leonardo Rangel-Castilla
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
| | - David Baskin
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
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Margetis K, Souweidane MM. Endoscopic Treatment of Intraventricular Cystic Tumors. World Neurosurg 2013; 79:S19.e1-11. [DOI: 10.1016/j.wneu.2012.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/02/2012] [Indexed: 10/14/2022]
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Carrasco R, Pascual JM, Medina-López D, Burdaspal-Moratilla A. Acute hemorrhage in a colloid cyst of the third ventricle: A rare cause of sudden deterioration. Surg Neurol Int 2012; 3:24. [PMID: 22439115 PMCID: PMC3307247 DOI: 10.4103/2152-7806.92932] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/24/2012] [Indexed: 12/04/2022] Open
Abstract
Background: Acute neurological deterioration and death in a patient harboring a colloid cyst of the third ventricle remains a poorly understood phenomenon. Sudden neurological derangement caused by spontaneous bleeding within a colloid cyst is a rare and potentially fatal event, usually requiring immediate diagnosis and emergency surgical treatment. Case Description: A 47-year-old male presented with acute right-sided hemiparesis and speech impediment, followed by rapid deterioration of consciousness. Neuroimaging studies showed a rounded mass at the roof of the anterior third ventricle, causing biventricular hydrocephalus along with a left-sided basal ganglia hematoma. The lesion showed scattered foci of a recent hemorrhage which extended into the left lateral ventricle. Surgical treatment involved emergency external ventricular drainage followed by the prompt elective total resection of the lesion via a transcallosal route. Pathological findings confirmed the diagnosis of a colloid cyst with focal areas of vascular congestion and blood extravasation within its wall. Conclusions: Spontaneous bleeding into a colloid cyst of the third ventricle may cause acute obstructive hydrocephalus and intracranial hypertension due to rapid enlargement of the lesion. This event may account for the sudden neurological deterioration and/or death observed in a previously asymptomatic patient. The diagnosis of hemorrhagic phenomena within a colloid cyst represents a challenge due to the variable signal usually displayed by these lesions on computed tomography (CT) and magnetic resonance imaging (MRI). Emergency ventricular drainage followed by elective tumoral removal constitutes a valid and safe treatment strategy.
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Affiliation(s)
- Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
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