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colloid_cyst

Colloid cyst

Colloid cysts are benign intracranial tumors usually occurring in the the roof of the third ventricle.

Clinical presentation

May be non-specific and heterogeneous. The problems are frequently associated with development of hydrocephalus, these cysts may cause.

In some patients the colloid cyst caused a sudden deterioration of consciousness due to an acute hydrocephalus in other the cyst was discovered accidentally, during the course of epileptic seizures treatment and due to chronic headache with quanti- and qualitative deterioration of consciousness in the setting of chronic hydrocefalus, respectively 1).

see Fatal colloid cyst.

see Colloid Cyst Risk Score.

Treatment

In a metaanalysis and systematic review microsurgical resection of colloid cysts is associated with a higher rate of complete resection, lower rate of recurrence, and fewer reoperations than with endoscopic removal. However, the rate of morbidity is higher with microsurgery than with endoscopy 2).

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 3).


Incidental colloid cysts are frequently managed with surveillance imaging rather than surgical excision. This approach is born out of their purported indolent growth pattern and the surgical morbidity associated with microsurgical removal. The advent of endoscopic colloid cyst removal may offer renewed assessment of these patients who carry a risk of acute neurological deterioration. An evidence-based recommendation should weigh the risks of operative treatment.

Age and cyst diameter were not correlated with the absence or presence of symptoms in patients with a colloid cyst of the third ventricle. Operative results were highly favorable in both groups and did not reveal a higher risk of morbidity in the patient presenting with an incidental lesion. The results support endoscopic resection as a legitimate therapeutic option for patients with incidental colloid cysts. Generalization of the operative results should be cautiously made, since this is a limited series and the results may depend on the degree of neuroendoscopic experience 4).

Endoscopy

Case series

2016

A 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. Beaumont et al 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 Colloid Cyst Risk Score (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).

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 5).


From a review of 94 patients, 10 (10.6%) patients had evidence of an extruded intraventricular solid fragment (median follow-up 4 months; range 0.5-115 months). Of the evaluable patients, 7 of 9 patients had T1-weighted hyperintense and T2-weighted hypointense cysts on preoperative scans. Seventy-eight percent of the extrusions were on the same side as the endoscopic entry. Three patients demonstrated early fragment migration, but not after 8 months of radiological follow-up. All evaluable patients demonstrated improvement in their hydrocephalus, and none suffered a complication attributable to the intraventricular extruded fragments.

Intraventricular extruded colloid fragments can occur after endoscopic resection, with the possible risk demonstrated as cyst hypointensity on preoperative T2-weighted images. The finding does not seem to result in any clinical morbidity, and radiographic involution is the rule. Migratory capacity, however, does exist and justifies a more frequent imaging surveillance schedule and consideration for removal 6).

Case reports

2016

Dorsch and Leonardo describe the case of a 42-year-old man who was found to have a colloid cyst of the third ventricle while undergoing evaluation for a dural arteriovenous fistula. They highlight the rotational, or “swiveling,” method for extraction of the colloid cyst 7).

1)
Ravnik J, Bunc G, Grcar A, Zunic M, Velnar T. Colloid cysts of the third ventricle exhibit various clinical presentation: a review of three cases. Bosn J Basic Med Sci. 2014 Aug 14;14(3):132-135. PubMed PMID: 25172970.
2)
Sheikh AB, Mendelson ZS, Liu JK. Endoscopic versus microsurgical resection of colloid cysts: a systematic review and meta-analysis of 1,278 patients. World Neurosurg. 2014 Dec;82(6):1187-97. doi: 10.1016/j.wneu.2014.06.024. Epub 2014 Jun 18. Review. PubMed PMID: 24952223.
3)
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 Jun 9;8:259. doi: 10.3389/fneur.2017.00259. eCollection 2017. PubMed PMID: 28649225; PubMed Central PMCID: PMC5465269.
4)
Margetis K, Christos PJ, Souweidane M. Endoscopic resection of incidental colloid cysts. J Neurosurg. 2014 Jun;120(6):1259-67. doi: 10.3171/2014.3.JNS131289. Epub 2014 Apr 18. PubMed PMID: 24745712.
5)
Beaumont TL, Limbrick DD Jr, Rich KM, Wippold FJ 2nd, Dacey RG Jr. Natural history of colloid cysts of the third ventricle. J Neurosurg. 2016 Dec;125(6):1420-1430. PubMed PMID: 26967781.
6)
Abdel Latif AM, Souweidane MM. Extruded contents of colloid cysts after endoscopic removal. J Neurosurg. 2016 Sep;125(3):570-5. doi: 10.3171/2015.6.JNS142676. Epub 2016 Jan 8. PubMed PMID: 26745480.
7)
Dorsch AB, Leonardo J. Use of the Swiveling Technique for Endoscopic Removal of a Colloid Cyst of the Third Ventricle: A Technical Note. J Neurol Surg A Cent Eur Neurosurg. 2016 Jul 18. [Epub ahead of print] PubMed PMID: 27429416.
colloid_cyst.txt · Last modified: 2017/08/14 11:41 by administrador