Endoscopic management of colloid cysts.

Background: Microsurgical resection, stereotactic aspiration, endoscopically assisted microsurgical resection, and ventriculoperitoneal shunt have been the treatment options for colloid cysts of the third ventricle. Recently, an endoscopic approach has been recognized as an effective alternative to open surgery. There is suspicion about the long-term recurrence rate and about obtaining complete removal of cyst.

Patients And Methods: This is a prospective study of 24 patients with colloid cyst who underwent endoscopic resection. Preoperative computed tomography (CT) scans revealed hydrocephalus in all the patients. Postoperative magnetic resonance imaging (MRI) was done in all cases.

Results: Age ranged from 16 to 57 years. There were 16 male and 8 female patients. The diameter of the cyst varied from 14 to 24 mm. Operating time ranged from 90 to 156 minutes. Total resection was achieved in 21 patients. All patients with subtotal excision underwent coagulation of residual cyst wall. The follow-up period ranged from 6 to 78 months (mean, 37 months). None of the patients developed any symptoms at 26, 31, and 39 months of follow-up. Preoperative symptoms disappeared in all the patients except for memory disorders and seizures in one patient each. No residual cyst was observed on the postoperative MRIs in 21 patients. Hospital stay was 4 to 10 days (median, 6 days). No endoscopic operation was converted into an open resection.

Conclusion: Endoscopic excision of a colloid cyst is an effective and safe alternate method. Although the follow-up time was short, residual cyst wall remained asymptomatic without any evidence of growth after subtotal excision and coagulation of wall.