scholarly journals Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection

2015 ◽  
Vol 123 (2) ◽  
pp. 352-356 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
David A. Wilson ◽  
Nicolas Olmo Koechlin ◽  
Hazem J. Abuhusain ◽  
Brian J. Dlouhy ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Extent Of Resection ◽  
Pineal Cyst ◽  
Presenting Symptoms ◽  
Parinaud’S Syndrome ◽  
Colloid Cysts ◽  
Potential Conditions ◽  
Visual Disturbances

OBJECT Surgical indications for patients with pineal cysts are controversial. While the majority of patients harboring a pineal cyst require no treatment, surgery is a well-accepted option for a subset of those patients with secondary hydrocephalus or Parinaud's syndrome. The majority of pineal cysts are identified incidentally during workup for other potential conditions, which may or may not be related to the presence of the cyst. In the absence of clear obstruction of CSF pathways, the treatment of presumed symptomatic pineal cysts is debatable. To clarify the role of surgery in these borderline cases, the authors reviewed their experience with resection of pineal cysts in the absence of ventriculomegaly or Parinaud's syndrome. METHODS The authors retrospectively reviewed medical records and imaging of all patients surgically treated between 2001 and 2014 with a pineal cyst in the absence of ventriculomegaly and Parinaud's syndrome. The presenting symptoms, preoperative cyst size, preoperative radiographic aqueductal compression, extent of resection, and radiographic and clinical follow-up were documented. RESULTS Eighteen patients (14 female and 4 male; mean age 24 years, range 4–47 years) underwent cyst resection in the absence of ventriculomegaly or Parinaud's syndrome. Presenting symptoms included headache (17 patients), visual disturbances (10 patients), gait instability (5 patients), dizziness (5 patients), episodic loss of consciousness (2 patients), and hypersomnolence (1 patient). The mean preoperative cyst diameter was 1.5 cm (range 0.9–2.2 cm). All patients had a complete resection. At a mean clinical follow-up of 19.1 months (range postoperative to 71 months), 17 (94%) patients had resolution or improvement of their presenting symptoms. CONCLUSIONS The authors' results suggest that ventriculomegaly and Parinaud's syndrome are not absolute requisites for a pineal cyst to be symptomatic. Analogous to colloid cysts of the third ventricle, intermittent occlusion of cerebrospinal fluid pathways may cause small pineal cysts to become intermittently symptomatic. A select cohort of patients with pineal cysts may benefit from surgery despite a lack of hydrocephalus or other obvious compressive pathology.

Purely Endoscopic Resection of Colloid Cysts

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS51-ONS56 ◽  
Author(s):  
Jeremy D.W. Greenlee ◽  
Charles Teo ◽  
Ali Ghahreman ◽  
Bernard Kwok
Keyword(s):  
Endoscopic Resection ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Foramen Of Monro ◽  
The Third ◽  
Colloid Cysts ◽  
Study Support

Abstract Objective: To further assess the safety and long-term efficacy of endoscopic resection of colloid cysts of the third ventricle. Methods: A retrospective review of a series of 35 consecutive patients (18 male, 17 female) with colloid cysts treated by endoscopic surgery was undertaken. Results: The mean patient age was 32.4 years (range, 11–54 yr). Headache was the most common presenting symptom (22 patients). The average tumor size was 18 mm (range, 3–50 mm). The endoscopic technique could not be completed in six patients, necessitating conversion to an open craniotomy and a transcortical approach to the colloid cyst. All patients had histologically confirmed colloid cysts of the third ventricle, and complete resection of the lesion was confirmed macroscopically and radiologically in all patients. There were no deaths. Two patients developed aseptic meningitis without any permanent sequelae. One patient developed unilateral hydrocephalus attributable to obstruction of the foramen of Monro, which was treated with endoscopic septum pellucidotomy. The median follow-up period was 88 months (range, 10–132 mo). There was one asymptomatic radiological recurrence. No seizures occurred after surgery. Conclusion: The results of this study support the role of endoscopic resection in the treatment of patients with colloid cysts as a safe and effective modality. In some cases, conversion to an open procedure may be required. Additional follow-up will be required to continue to address the duration of lesion-free survival.

Cavernous Malformations in and Around the Third Ventricle: Indications, Approaches, and Outcomes

2019 ◽  
Vol 18 (6) ◽  
pp. 736-746
Author(s):  
M Neil Woodall ◽  
Joshua S Catapano ◽  
Michael T Lawton ◽  
Robert F Spetzler
Keyword(s):  
Third Ventricle ◽  
Lateral Wall ◽  
Clinical Results ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Presenting Symptoms ◽  
The Third

Abstract BACKGROUND Cavernous malformations in structures in and around the third ventricle are a challenging conceptual and surgical problem. No consensus exists on the ideal approach to such lesions. OBJECTIVE To perform a retrospective review of our institutional database to identify and evaluate approaches used to treat cavernous malformations located in and around the third ventricle. METHODS Information was extracted regarding lesion size and location, extent of resection, time to last follow-up, surgical approach, presenting symptoms, preoperative and postoperative neurological status, and specific approach-related morbidity. RESULTS All 39 neurosurgical operations (in 36 patients) were either an anterior interhemispheric (AIH) (44%, 17/39) or a supracerebellar infratentorial (SCIT) (56%, 22/39) approach. Gross-total resection was achieved in 23 of 39 procedures (59%), a near-total resection in 1 (3%), and subtotal resection in 15 (38%). For the 31 patients with at least 3 mo of follow-up, the mean modified Rankin Scale (mRS) score was 1.5. Of the 31 patients, 25 (81%) had an mRS score of 0 to 2, 4 had a mRS score of 3 (13%), and 1 each had a mRS score of 4 (3%) or 5 (3%). CONCLUSION Most approaches to cavernous malformations in and around the third ventricle treated at our institution have been either an AIH or a SCIT approach. The AIH approach was used for lesions involving the lateral wall of the third ventricle or the midline third ventricular floor, whereas the SCIT approach was used for lesions extending from the third ventricle into the dorsolateral midbrain, with acceptable clinical results.

scholarly journals PC3 - 152 Impact of Extent of Resection Upon Outcome in Newly Diagnosed Glioblastoma: A Study in the Molecular Era

2016 ◽  
Vol 43 (S4) ◽  
pp. S17-S18
Author(s):  
W.M.H. Sayeed ◽  
E. Batuyong ◽  
J.C. Easaw ◽  
M. Pitz ◽  
J.J.P. Kelly
Keyword(s):  
Multivariable Analysis ◽  
Extent Of Resection ◽  
Postal Code ◽  
Newly Diagnosed ◽  
Presenting Symptoms ◽  
Tumour Location ◽  
Newly Diagnosed Glioblastoma ◽  
Molecular Marker Analysis

For decades, debate has persisted regarding the role of surgical resection in newly diagnosed glioblastoma. There is increasing evidence that extent of resection (EoR) is an independent prognostic factor. Previous work has proposed the inclusion of EoR in a risk stratification algorithm but does not incorporate account recent advances in the molecular characterization of tumours. We set out to investigate the effect of EoR on overall survival (OS), and to develop a stratification algorithm incorporating both EoR and modern molecular markers for prognostication. HYPOTHESIS: Greater EoR is independently associated with improved OS. METHODS: We examined 190 consecutive cases of histopathologically confirmed newly-diagnosed glioblastoma who were operated upon between January 1, 2012 and December 31, 2014. Variables including age, sex, postal code, KPS, tumour location, presenting symptoms, treatment history, date of progression, date of reoperation, as well as MGMT, IDH, 1p/19q codeletion, and ATRX status were recorded. Preoperative and postoperative MRIs were reviewed and volumetric tumour burden will be analyzed and EoR will be calculated. RESULTS: Preliminary EoR calculations (n=18) show a positive correlation between EoR and OS. CONCLUSION: A correlation exists between EoR and OS, although multivariable analysis is planned to exclude potential confounders. MRI review, chart review including molecular marker analysis and EoR calculations are ongoing.

scholarly journals P.014 The natural history of third ventricle colloid cysts includes asymptomatic regression: a report of two cases and review of the literature

2017 ◽  
Vol 44 (S2) ◽  
pp. S17-S17
Author(s):  
R Bokhari ◽  
J Chankowsky ◽  
J Marcoux
Keyword(s):  
Natural History ◽  
Third Ventricle ◽  
Symptomatic Patient ◽  
Review Of The Literature ◽  
Indication For Surgery ◽  
Asymptomatic Patients ◽  
Signal Characteristics ◽  
History Of ◽  
Colloid Cysts

Background: Colloid cysts of the third ventricle are a rare entity with an unclear natural history. Although intervening in the setting of a symptomatic patient is fairly straightforward, decision-making for asymptomatic patients is not. Few studies address this question and proposed risk factors for cyst progression vary.A cyst diameter exceeding 1 cm is a common indication for surgery. This is rooted in the belief that the natural history is continued growth. A few cases have recently surfaced that suggests some cysts may spontaneously regress without complication. We describe our experience with two such cases and contrast it with those of others. Methods: We collected all cases of “colloid cysts” identified as incidental findings on Brain CT scans in a large urban center with available follow-up. We then conducted a comprehensive review of the literature. Results: Among all incidental cases from our database, none required surgery and two were found to decrease in size on neuroimaging surveillance with interesting evolution in MRI signal characteristics. These cysts remain asymptomatic at last follow up. Conclusions: The natural history of colloid cysts includes spontaneous regression. This should be mentioned in counseling asymptomatic patients.

Suprasellar germinoma

1978 ◽  
Vol 49 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Juji Takeuchi ◽  
Hajime Handa ◽  
Izumi Nagata
Keyword(s):  
Third Ventricle ◽  
Plasma Concentrations ◽  
Pineal Region ◽  
Content Type ◽  
Intracranial Germinoma ◽  
Suprasellar Germinoma ◽  
Neuroradiological Examination ◽  
Tomography Scanning ◽  
Visual Disturbances

✓ The clinical features of 18 cases of suprasellar germinoma were reviewed, and the following points stressed: 1) The incidence of intracranial germinoma and teratoma seems to be much higher in Japan than elsewhere. 2) Germinomas in the pineal region, the third ventricle, and the lateral ventricle were observed to be predominant in males. In suprasellar germinoma, however, males were not affected predominantly and the male:female ratio was 1:1. 3) Suprasellar germinomas caused three symptoms: diabetes insipidus, visual disturbances, and pituitary dysfunctions. 4) Pituitary functions were disturbed to various degrees. Some cases showed hypopituitarism but some showed an elevation of plasma concentrations of cortisol or luteinizing hormone and follicle stimulating hormone. 5) Some abnormalities showing a suprasellar mass were usually found on neuroradiological examination. 6) Suprasellar germinomas were very sensitive to radiotherapy and some of them rapidly disappeared on follow-up computerized tomography scanning after irradiation with as little as 1200 rads.

Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy

1989 ◽  
Vol 70 (4) ◽  
pp. 525-529 ◽  
Author(s):  
Chad D. Abernathey ◽  
Dudley H. Davis ◽  
Patrick J. Kelly
Keyword(s):  
Third Ventricle ◽  
Total Removal ◽  
Total Resection ◽  
Content Type ◽  
The Third ◽  
Cyst Aspiration ◽  
Colloid Cysts ◽  
Mass Lesions ◽  
Fine Print

✓ The therapeutic strategies employed in the management of anterior third-ventricular mass lesions remain controversial. Resection by conventional craniotomy, whether via a transcallosal or transcortical approach, carries well-known risks and limitations. Alternatively, in this region traditional stereotaxy has been relegated to use with biopsy only or cyst aspiration procedures. Combining aspects of both conventional and stereotaxic techniques has allowed total removal of 12 colloid cysts in six women and six men ranging in age from 25 to 71 years. No mortality and minimal morbidity have been associated with the procedures. There has been no evidence of recurrence in an average follow-up period of 19 months. By coupling the benefits of stereotaxic precision and localization to the microsurgical management of colloid cysts, several rewards have been realized: 1) only a limited cortical dissection is needed; 2) the hazards of callosal or forniceal injury can be avoided; 3) the lesion is easily localized regardless of ventricular size; 4) hemostasis can be readily achieved with bipolar cautery or defocused laser power; and 5) most importantly, a total resection is possible with little risk to the patient. Stereotaxic microsurgical laser craniotomy provides a new option for the management of colloid cysts and other anterior third-ventricular lesions.

Third ventricle colloid cysts: a consecutive 12-year series

1997 ◽  
Vol 86 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Tiit Mathiesen ◽  
Per Grane ◽  
Lars Lindgren ◽  
Christer Lindquist
Keyword(s):  
Third Ventricle ◽  
Colloid Cyst ◽  
Memory Deficit ◽  
Individual Treatment ◽  
Content Type ◽  
Colloid Cysts ◽  
Permanent Morbidity ◽  
Radiological Studies ◽  
Fine Print

✓ A continuous follow-up review of colloid cysts including aspects of natural history and evaluation of treatment options is necessary to optimize individual treatment. Thirty-seven consecutive patients with colloid cyst of the third ventricle seen at Karolinska Hospital between 1984 and 1995 were reviewed. Five patients were admitted in a comatose state, and two died despite emergency ventriculostomy. Three had recurrent cysts following previous aspiration procedure. During the study period, patients underwent a total of 10 ventriculostomies, 10 aspirations, 26 microsurgical operations, and two shunt operations. Twenty-four of 26 microsurgical operations were transcallosal and two were transcortical. Twenty-four operations (22 transcallosal and two transfrontal approaches) without permanent morbidity were performed by four surgeons. Transient memory deficit from forniceal traction was noted in 26%. The remaining two transcallosal operations, which led to permanent morbidity or mortality, were performed by two different surgeons. Aspiration of cysts performed by four different surgeons carried a 40% risk of transient memory deficit (10% permanent) and an 80% recurrence rate. One patient was found to be cured on radiological studies obtained at the 5-year follow-up review. Seven cysts were followed by means of radiological studies with no treatment for 6 to 37 months. Five of these cysts grew, indicating that younger patients with colloid cysts will probably need surgical treatment. The main causes of unfavorable results were: 1) failure to investigate symptoms that proved fatal; 2) subtotal resection; and 3) surgical complications. Transcallosal microsurgery produced excellent results when performed by experienced surgeons. A colloid cyst of the foramen of Monro is a disease that should be detected before permanent neurological damage has occurred. Permanent morbidity or mortality should not be accepted in modern series of third ventricle colloid cysts.

scholarly journals Dermoid Cyst of the Prepontine Cistern and Meckel's Cave: Illustrative Case and Systematic Review

2017 ◽  
Vol 79 (02) ◽  
pp. 139-150 ◽  
Author(s):  
Lawrance Chung ◽  
Carlito Lagman ◽  
Courtney Duong ◽  
Daniel Nagasawa ◽  
Alexander Tucker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dermoid Cyst ◽  
Surgical Excision ◽  
Extent Of Resection ◽  
Symptom Improvement ◽  
Illustrative Case ◽  
Recurrence Rates ◽  
Prepontine Cistern ◽  
Presenting Symptoms ◽  
Visual Disturbances

Objective Dermoid cysts are benign, congenital malformations that account for ∼0.5% of intracranial neoplasms. The authors describe a 42-year-old female with a prepontine dermoid cyst who underwent apparent gross total resection (GTR) but experienced cyst recurrence. To date, very few cases of prepontine dermoid cysts have been reported. The prevalent region where these cysts are located can be difficult to determine. In addition, the authors systematically review the literature to characterize the clinical presentation, anatomical distribution, and surgical outcomes of intracranial dermoid cysts. Design Systematic review. Setting/Participants PubMed, Web of Science, and Scopus databases. Main Outcome Measures Extent of resection, symptom improvement, and recurrence rates. Results A total of 69 patients with intracranial dermoid cysts were identified. Three (4.3%) intracranial dermoid cysts were located in the prepontine cistern. The average age of patients was 33.3 years. The most common presenting symptoms were headache (52.2%) and visual disturbances (33.3%). Intracranial dermoid cysts were distributed similarly throughout the anterior, middle, and posterior cranial fossae (29.0%, 36.2%, and 29.0%, respectively). GTR was achieved in 42.0% of cases. Thirty-four (49.3%) patients experienced symptom resolution. Recurrence rate was 5.8% at a mean follow-up of 2.1 years. Conclusions Intracranial dermoid cysts most often present as headaches and visual disturbances. Intracranial dermoid cysts were found in the anterior, middle, and posterior cranial fossae at similar frequencies but with clear predilections for the Sylvian fissure, sellar region, and cerebellar vermis. Outcomes following surgical excision of intracranial dermoid cysts are generally favorable despite moderate rates of GTR.

Aortic aneurysms after correction of aortic coarctation: A systematic review

VASA ◽  
2010 ◽  
Vol 39 (1) ◽  
pp. 3-16 ◽  
Author(s):  
von Kodolitsch ◽  
Aydin ◽  
Bernhardt ◽  
Habermann ◽  
Treede ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Aortic Coarctation ◽  
Significant Risk ◽  
Coarctation Of The Aorta ◽  
Aortic Aneurysms ◽  
Percutaneous Therapy ◽  
Presenting Symptoms

Despite advanced techniques for surgical or percutaneous therapy coarctation of the aorta continues to carry a high risk of aneurysmal formation. Mortality of these aneurysms ranges between <1 and >90%, reflecting remarkable differences in surgical strategies and the follow-up management of coarctation. We review the frequency, anatomical types, risk factors and mechanisms of aortic aneurysm forming late after surgical or percutaneous therapy of aortic coarctation. We emphasize that aneurysms do not form exclusively at the site of previous intervention, but also at remote locations such as the ascending aorta. Moreover, aneurysm formation may only in part be attributed to a specific technique of coarctation therapy, and we emphasize the role of a bicuspid aortic valve and inherent weakness of the aortic wall as significant risk factors for aneurysm after aortic coarctation. We report the presenting symptoms, follow-up protocols, and imaging criteria for local and proximal aneurysms. Finally, we discuss criteria for prophylactic intervention at the site of such aneurysms, and present therapeutic options for different types of aneurysms. With this systematic review, we wish to provide data for establishing more uniform strategies for preventing, diagnosing and treating aneurysms associated with aortic coarctation.

scholarly journals Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity

2015 ◽  
Vol 39 (2) ◽  
pp. E8 ◽  
Author(s):  
Mohammed Abdulaziz ◽  
Grant W. Mallory ◽  
Mohamad Bydon ◽  
Rafael De la Garza Ramos ◽  
Jason A. Ellis ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Adjuvant Radiotherapy ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Myxopapillary Ependymoma ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
En Bloc

OBJECT While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. METHODS A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. RESULTS Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7–68 years). The median follow-up was 51.5 months (range 12–243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. CONCLUSIONS A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.

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