Colloid cyst resection

• Intracavitary Yttrium-90 Colloid Therapy for Cystic Sellar Masses: A Phase II Clinical Trial With 5-Year Follow-Up
• Clinical symptoms and surgical outcome of colloid cysts of the third ventricle: A multicenter retrospective study
• Tailored Callosotomy in Third Ventricle Colloid Cyst Resection via Anterior Interhemispheric Transcallosal Approach
• Neurocognitive Safety of Endoscopic Colloid Cyst Resection: Paired Pre- and Post-Operative Cognitive Function from an Exploratory Cohort
• Revisiting the Endoscopic vs. Microscopic colloid cysts resection battle with emphasis on endoscope assisted technique
• Rosette-Forming Glioneuronal Tumor Mimicking Foramen Monro Colloid Cyst: Case Presentation and Systematic Literature Review
• Intracranial Cysts: A Single-Institution Experience With 27 Surgically Managed Cases
• Emergency Resection of a Large Third Ventricle Colloid Cyst: Ipsilateral vs. Contralateral Interhemispheric Approach Based on the Hydrocephalus Status

The colloid cyst treatments has evolved rapidly since the first successful excision of a colloid cyst via the transcortical transventricular approach by Walter Dandy in 1921 ¹⁾. This was followed closely by a transcallosal approach by Greenwood in 1949 ²⁾.

There is a lack of consensus regarding the preferred surgical strategy for colloid cyst resection; the technique with the optimal rates of remission, recurrence, mortality, and complications is debatable.

The ultrasonic aspirator can be used safely and effectively for the resection of colloid cysts of the third ventricle, achieving high rates of complete resection with minimal postoperative complications ³⁾.

Microsurgical resection of third ventricle colloid cysts was associated with a higher rate of GTR and a lower rate of recurrence, while there was a lower rate of postoperative complications, duration of surgery, and shorter hospitalization period in the endoscopic group ⁴⁾.

Surgical resection of recurrent colloid cysts should focus on complete removal of the cyst wall to minimize the chance of recurrence. Microsurgery has been shown to provide the highest success rates for cyst wall resection and lowest rates of recurrence and is therefore recommended for patients undergoing surgery for primary and recurrent colloid cysts ⁵⁾.

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

This meta-analysis of 1278 patients comparing endoscopic and various microsurgical techniques found that the microsurgical group had a significantly greater extent of resection (96.8% vs. 58.2%), lower rates of recurrence (1.48% vs. 3.91%), and lower rates of reoperation than the endoscopic group (0.38% vs. 3.0%). Both groups had similar rates of mortality (1.4% vs. 0.6%) and shunt dependency (6.2% vs. 3.9%). Overall, the complication rate was lower in the endoscopic group than in the microsurgical group (10.5% vs. 16.3%). Within the microsurgery group, the transcallosal approach had a lower overall morbidity rate (14.4%) than the transcortical approach (24.5%) ⁶⁾.

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 ⁷⁾.

The study aims to introduce and assess a precise microsurgical technique for managing colloid cysts using the anterior interhemispheric transcallosal approach.

The research involved a retrospective analysis of 14 cases between 2021 and 2023 treated with the anterior interhemispheric transcallosal approach by two experienced skull base surgeons. The evaluation encompassed demographic, clinical, radiological, histological, and surgical data. Additionally, the Colloid Cyst Risk Score (CCRS) was used to assess the risk of obstructive hydrocephalus. The procedure incorporated neuronavigation and ultrasound to determine the precise entry point and to plan the trajectory.

The minimally invasive microsurgical technique was employed in all 14 cases, with no reported postoperative complications. Post-surgery MRI scans confirmed complete cyst removal, with an average callosotomy measurement of 5.4 ± 2.5 mm. Importantly, none of the patients experienced disconnection syndrome associated with callosotomy.

The adapted microsurgical approach via the anterior interhemispheric transcallosal approach method emerges as a secure and efficient way to address colloid cysts. It ensures comprehensive cyst removal while minimizing complications, boasting advantages such as reduced invasiveness, enhanced visibility, and minimal tissue disturbance, thereby confirming its role in colloid cyst surgical interventions ⁸⁾.

The authors conclude that their approach is safe and effective for colloid cyst resection, minimizing complications while ensuring complete removal.

✔ Strength: Their findings are clinically relevant and could inform future refinements in transcallosal approaches.

✘ Limitations:

Lack of prospective validation. Future studies should use randomized or prospective comparative designs to confirm benefits. Long-term functional outcomes are missing—neurocognitive follow-up would provide a more comprehensive assessment.

Colloid cyst endoscopy.

Colloid cyst resection complications