Series of Neuroendoscopic Resection of Colloid Cysts

Emory Neurosurgery Reports Largest Single-Institution Series of Neuroendoscopic Resection of Colloid Cysts

Debate remains whether complete excision of colloid cysts, including capsule and contents, can be achieved routinely by the pure endoscopic method. Costas Hadjipanayis, MD, reported the largest single-institution series of 42 patients who underwent complete neuroendoscopic resection of their colloid cyst. Hadjipanayis presented his findings at the American Association of Neurological Surgeons Annual Scientific Meeting 2011 in Denver, CO.

Methods:

All 42 symptomatic patients underwent neuroendoscopic resection with a 6.3 mm rigid rod-lens working channel endoscope after placement through a 2 cm skin incision and a 6.5 mm right frontal burr hole. Three patients had prior ventriculoperitoneal shunts placed for treatment of their hydrocephalus and one patient had a residual colloid cyst after prior surgery. Fifty-two percent of patients (22/42) had evidence of preoperative obstructive hydrocephalus.

Results:

Average patient age was 39 years old (range 14 to 67). Average operative time was 90 minutes. Patients (36/42; 86%) were discharged home after a median hospitalization of four days. All 42 patients underwent complete resection of their colloid cyst (capsule and contents) based on postoperative imaging and intraoperative inspection.

Median clinic follow-up was 15 months (range 1 to 28; three patients lost to follow-up). Twenty-six patients had a follow-up MRI with no residual or recurrence present (median 15 months, range 1 to 36). One perioperative death occurred in a patient with post-operative alcohol withdrawal syndrome. Three patients required VPS placement. Two-thirds of patients with prior VPSs underwent removal of their VPS and were shunt-free.

Conclusion:

Complete neuroendoscopic resection of colloid cysts is routinely possible in a safe and minimally invasive manner with a short operative time and good outcomes and may be a favorable treatment for patients.