Interhemispheric transcallosal transforaminal approach and its variants to colloid cyst of third ventricle: Technical issues based on a single institutional experience of 297 cases

Background. Third ventricle tumors are uncommon and account for only 0.6 - 0.9% of all the brain tumors7. In 1921, Dandy was the first neurosurgeon who successfully removed a colloid cyst from the third ventricle through a posterior transcallosal approach. Despite their unfavourable locations, these tumours can be removed successfully by proper knowledge of anatomical landmarks and by choosing the appropriate approach. Methods. We performed a retrospective analysis of all patients (17 patients) who underwent surgery for anterior third ventricular masses between March 2018 to March 2020 in the Dr Ram Manohar Lohia Institute of Medical Science Lucknow, Uttar Pradesh. Results: The most common symptom in our cases was headache, which was present in all (100%) patients, nausea/vomiting in 7 (41%), history of recurrent episodes of drop attacks in 4 (23%), h/o seizure in 2 (11.7%), visual disturbance in 1 (5.4%), memory disturbance in 1 (5.4%) and urinary incontinence in 1 (5.4%) patient. 6 patients were operated with transcallosal-transforaminal approach, 1 patient was operated with transcallosal interforniceal approach, 3 patients were operated with transcortical-transforaminal approach, 1 patient was operated with subfrontal translamina terminalis approach, 1 patient was operated with transcallosal-transchoroidal approach, 5 patients were operated with endoscopically. Gross total excision was achieved in 15 (88%) patients while in 2 (11.7%) patients subtotal resection was done due to their adherence to choroid plexus and optic chiasm. The most common post-operative complication was endocrine dysfunction in the form of diabetes insipidus. Conclusions. Anterior Third ventricular tumours are mostly benign and best treatment modality is surgical resection. When we analyzed the results of various approaches, we found that despite their unfavourable location, the results were satisfactory for different tumours of different location in the anterior third ventricle, when treated with the carefully planned microsurgical or endoscopic approach with proper knowledge of anatomical landmarks.

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Direct Inspection with Dual Endoscope Technique via Bilateral Transforaminal Approach Leading to Complete Resection of Recurrent Colloid Cyst of the Third Ventricle

World Neurosurgery ◽

10.1016/j.wneu.2020.06.060 ◽

2020 ◽

Vol 141 ◽

pp. 272-277

Author(s):

Atsushi Nakayashiki ◽

Tomohiro Kawaguchi ◽

Kuniyasu Niizuma ◽

Mika Watanabe ◽

Miki Fujimura ◽

...

Keyword(s):

Third Ventricle ◽

Colloid Cyst ◽

Complete Resection ◽

The Third ◽

Transforaminal Approach ◽

Direct Inspection

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Development and evaluation of a patient-specific surgical simulator for endoscopic colloid cyst resection

Journal of Neurosurgery ◽

10.3171/2019.4.jns183184 ◽

2020 ◽

Vol 133 (2) ◽

pp. 521-529 ◽

Cited By ~ 1

Author(s):

Vivek P. Bodani ◽

Gerben E. Breimer ◽

Faizal A. Haji ◽

Thomas Looi ◽

James M. Drake

Keyword(s):

Choroid Plexus ◽

Computer Aided Design ◽

Third Ventricle ◽

Colloid Cyst ◽

Comfort Level ◽

Complex Case ◽

Patient Specific ◽

Surgical Simulator ◽

Perceived Realism ◽

Noncontrast Ct

OBJECTIVEEndoscopic resection of third-ventricle colloid cysts is technically challenging due to the limited dexterity and visualization provided by neuroendoscopic instruments. Extensive training and experience are required to master the learning curve. To improve the education of neurosurgical trainees in this procedure, a synthetic surgical simulator was developed and its realism, procedural content, and utility as a training instrument were evaluated.METHODSThe simulator was developed based on the neuroimaging (axial noncontrast CT and T1-weighted gadolinium-enhanced MRI) of an 8-year-old patient with a colloid cyst and hydrocephalus. Image segmentation, computer-aided design, rapid prototyping (3D printing), and silicone molding techniques were used to produce models of the skull, brain, ventricles, and colloid cyst. The cyst was filled with a viscous fluid and secured to the roof of the third ventricle. The choroid plexus and intraventricular veins were also included. Twenty-four neurosurgical trainees performed a simulated colloid cyst resection using a 30° angled endoscope, neuroendoscopic instruments, and image guidance. Using a 19-item feedback survey (5-point Likert scales), participants evaluated the simulator across 5 domains: anatomy, instrument handling, procedural content, perceived realism, and confidence and comfort level.RESULTSParticipants found the simulator’s anatomy to be highly realistic (mean 4.34 ± 0.63 [SD]) and appreciated the use of actual instruments (mean 4.38 ± 0.58). The procedural content was also rated highly (mean 4.28 ± 0.77); however, the perceived realism was rated slightly lower (mean 4.08 ± 0.63). Participants reported greater confidence in their ability to perform an endoscopic colloid cyst resection after using the simulator (mean 4.45 ± 0.68). Twenty-three participants (95.8%) indicated that they would use the simulator for additional training. Recommendations were made to develop complex case scenarios for experienced trainees (normal-sized ventricles, choroid plexus adherent to cyst wall, bleeding scenarios) and incorporate advanced instrumentation such as side-cutting aspiration devices.CONCLUSIONSA patient-specific synthetic surgical simulator for training residents and fellows in endoscopic colloid cyst resection was successfully developed. The simulator’s anatomy, instrument handling, and procedural content were found to be realistic. The simulator may serve as a valuable educational tool to learn the critical steps of endoscopic colloid cyst resection, develop a detailed understanding of intraventricular anatomy, and gain proficiency with bimanual neuroendoscopic techniques.

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Cerebrospinal fluid rhinorrhea and acquired anterior basal encephalocoele in a patient with colloid cyst of the third ventricle

Neurology India ◽

10.4103/0028-3886.60431 ◽

2010 ◽

Vol 58 (1) ◽

pp. 156 ◽

Cited By ~ 2

Author(s):

Chandrasekharan Kesavadas ◽

TirurRaman Kapilamoorthy ◽

Gireesh Menon ◽

KythasandraShivakumar Deepak

Keyword(s):

Cerebrospinal Fluid ◽

Third Ventricle ◽

Colloid Cyst ◽

Cerebrospinal Fluid Rhinorrhea ◽

The Third

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Colloid cyst of third ventricle

Annals of Emergency Medicine ◽

10.1016/s0196-0644(83)80142-5 ◽

1983 ◽

Vol 12 (1) ◽

pp. 60-61

Author(s):

Douglas R. Morgart

Keyword(s):

Third Ventricle ◽

Colloid Cyst

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Limbic system symptomatology associated with colloid cyst of the third ventricle

Journal of Neurology ◽

10.1007/bf00314222 ◽

1989 ◽

Vol 236 (1) ◽

pp. 60-61 ◽

Cited By ~ 9

Author(s):

A. A. Faris ◽

C. F. Terrence

Keyword(s):

Limbic System ◽

Third Ventricle ◽

Colloid Cyst ◽

The Third

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In Reply to the Letter to the Editor Regarding “Postexercise Death Due to Hemorrhagic Colloid Cyst of Third Ventricle: Case Report and Literature Review”

World Neurosurgery ◽

10.1016/j.wneu.2021.06.083 ◽

2021 ◽

Vol 153 ◽

pp. 153

Author(s):

Joshua A. Cuoco ◽

Cara M. Rogers

Keyword(s):

Case Report ◽

Literature Review ◽

Third Ventricle ◽

Colloid Cyst ◽

Letter To The Editor

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COLLOID CYSTS OF THE THIRD VENTRICLE: A REVIEW OF SIXTEEN CASES

10.36106/ijsr/0102258 ◽

2021 ◽

pp. 62-64

Author(s):

Y Srinivas Rao ◽

Hemal Chheda ◽

Ch Surendra ◽

M V Vijayasekhar ◽

K Satya Varaprasad

Keyword(s):

Benign Lesion ◽

Third Ventricle ◽

Clinical Manifestations ◽

Colloid Cyst ◽

Surgical Approaches ◽

Imaging Features ◽

Complete Excision ◽

Advantages And Disadvantages ◽

The Third ◽

Colloid Cysts

BACKGROUND : Colloid cysts are one of the rare brain tumours and are mostly located in the anterosuperior portion of the third ventricle, between the fornix and surround of Foramen of Monroe. OBJECTIVES: Ÿ 1.To review the demographic information & analyse clinical manifestations of patients presenting with colloid cyst of third ventricle. Ÿ 2.To analyze the advantages and disadvantages of various surgical approaches Ÿ 3.To assess the surgical outcome in colloid cyst patients operated by any method. MATERIALS AND METHODS: A retrospective study was performed on 16 patients who presented with a colloid cyst and underwent surgery at the Department of Neurosurgery, King George Hospital, Andhra Medical College between 2013-2018. They were evaluated based on clinical ndings and imaging features, surgical approaches used for resection and their outcomes. RESULTS: Sixteen cases of colloid cyst of the third ventricle were operated upon between 2013-2018. There were seven male and nine female patients with their ages varying between 9 and 62 years old. Nine patients were operated on by using a transcortical trans-ventricular approach, four using the anterior trans-callosal approach and, three patients by using an endoscopic approach. In all patients, complete excision of the lesions was achieved. CONCLUSION: Colloid cysts, though benign, present surgical challenges because of its deep midline location. Complete excision of the colloid cyst carries an excellent prognosis. Surgery is a safe and effective treatment option for this benign lesion.

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COLLOID CYST OF THE THIRD VENTRICLE

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.01.2206 ◽

2010 ◽

Vol 17 (01) ◽

pp. 156-163

Author(s):

NAVEED ASHRAF ◽

MUHAMMAD AKMAL AZEEMI ◽

FAUZIA SAJJAD ◽

Asma Ghouri

Keyword(s):

Clinical Success ◽

Standard Procedure ◽

Third Ventricle ◽

Colloid Cyst ◽

Invasive Approach ◽

Keyhole Surgery ◽

The Third ◽

Number Of Patients ◽

Colloid Cysts ◽

Microsurgical Resection

Objectives: Cerebrospinal fluid shunting or microsurgical resection of the colloid cysts of the third ventricle have long been a standard treatment. The emergence of neuroendoscopy has lead to its application in various neurosurgical problems. Colloid cyst of the third ventricle is one such pathology where endoscopic treatment has been performed with great clinical success during the past decade. We now Although considered less efficacious than microsurgical excision endoscopic excision is less invasive and much simpler.Objectives: (1) to assess the extent of excision (2) to assess the morbid anatomy of the colloid cyst (3) to assess the risk of complications (4) to assess the functional outcome. Period: Eight years (Jul 2001-June 2009) Materials and Methods: Endoscopic resections of 15 colloid cysts of the third ventricle with obstruction of Foramina of Monroe in all cases. Results: Total removal was achieved in 10 (66.7%) cases. In 5 (33.3%) patients the colloid material was evacuated completely while the remnant of the capsule adherent to its origin was left behind. Two (13.3%) patients developed meningitis one week postoperatively and one diedsubsequently. Nine (60%) patients had excellent recovery as the symptoms were relieved during a period of 3 to 24 months. Five (33.3%) of the total patients required ventriculoperitoneal shunt for obstructivey drocephalus which developed with in 2 weeks after surgery. One out of the total number of patients deteriorated postoperatively on the existing neurological deficit. There has not been any recurrence until now with subtotal excision of the capsule. Conclusions: Keyhole surgery under endoscopic visual control offers an alternative, very effective minimally invasive approach for the excision of colloid cyst of the third ventricle and is likely to replace microsurgical resection as a standard procedure.

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Third ventricular colloid cyst causing acute hydrocephalus during early pregnancy: Clinical lessons from a case

Surgical Neurology International ◽

10.25259/sni_724_2020 ◽

2021 ◽

Vol 12 ◽

pp. 54

Author(s):

Ching Chung Foo ◽

Pasquale Gallo ◽

Chandrasekaran Kaliaperumal

Keyword(s):

Obstructive Hydrocephalus ◽

Third Ventricle ◽

False Negative ◽

Colloid Cyst ◽

Radiological Investigation ◽

Foramen Of Monro ◽

Acute Hydrocephalus ◽

Healthy Neonate ◽

Trimester Pregnancy ◽

Colloid Cysts

Background: Colloid cysts of third ventricle are rare lesions which may present with symptoms of acute hydrocephalus. We report a case of acute obstructive hydrocephalus secondary to third ventricular colloid cyst and its management during 1st trimester pregnancy. Case Description: A 31-years-old lady presented to the emergency department with reduced consciousness. Computed tomography head showed obstructive hydrocephalus and an obstructing lesion near foramen of Monro suggestive of third ventricle colloid cyst. She underwent endoscopic resection of colloid cyst. Her pregnancy was only confirmed after surgery and she delivered a healthy neonate at full term. She has remained clinically well and had resumed her work as a general practitioner. Conclusion: This case illustrates that urinary pregnancy test may show false negative result but pregnancy should not preclude radiological investigation and neurosurgical intervention in patients with deteriorating neurological function.

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