Obstruction at the level of foramen of monro causing obstructive hydrocephalus

Background: The foramen of monro is also known by the name of interventricular foramen. The study was conducted to determine the etiology, clinical picture, radiological features, and different modalities of management and related complications.Methods: A prospective study of 30 cases with diagnosis of hydrocephalus due to obstruction at the interventricular foramen. Lesions at the foramen of monro were addressed either by open craniotomy approach or neuroendoscopy approach. For open craniotomy transcortical or interhemispheric approach was preferred and Karl Storz’s LOTTA system was used for all the neuroendoscopic procedures.Results: Craniopharyngioma and colloid cysts were the most common pathology in children and adults respectively. Endoscopic approach was particularly helpful in decreasing the convalescence period and postoperative complications. Wound site CSF leak is the most commonly faced complications. In our study, out of 30 patients, males accounted for 23 (77%) cases and females for 7 (23%) cases. Majority were in the age group of 20-40 years. The most common presenting complaints of patients having foramen of monro obstruction with hydrocephalus were headache and vomiting. Gadolinium enhanced contrast MRI of brain was the investigation of choice for diagnosing these lesions.Conclusions: Endoscopic approach can be offered as a first line of treatment as a part of standard treatment in all patients having foramen of monro obstruction. It obviates the need for multiple shunt procedures. Although small solid lesions less than 3 cm in size can be addressed by endoscopic approach, the learning curve required for endoscopic approach to deal with solid lesions is very steep.

Third ventricle colloid cysts: An endoscopic case series emphasizing technical variations

Background: Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to assess the results of endoscopic surgery using mainly aspiration and coagulation without complete capsule resection and discuss the rationale for the procedure. Methods: A retrospective review was conducted of 45 consecutive symptomatic patients with third ventricle colloid cysts that were surgically treated with purely endoscopic surgery from 1997 to 2018. Results: Mean age was 35.4 years. Male-to-female ratio was 1:1. Clinical presentation included predominantly headache (80%). Transforaminal was the most used route (71.1%) followed by transeptal (24.5%) and interforniceal (4.4%). Capsule was intentionally not removed in 42 patients (93.3%) and cyst remnants were absent on postoperative MRI in 36 (85%). Mild complications occurred in 8 patients (17.8%). Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications, shunts or deaths. Follow-up did not show any recurrence or remnant growth that needed further treatment. Conclusion: Gross total resection may not be the main objective for every situation. Subtotal resection without capsule removal seems to be safer while preserving good results, especially in a limited resource environment. Remnants left behind should be followed but tend to remain clinically asymptomatic for the most part. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings.

Transsphenoidal endoscopic treatment of cysts of the chiasmo-sellar region

Introduction. Cysts of the chiasmo-sellar region include Rathke cleft cysts, colloid cysts, arachnoid cysts, dermoid cysts, and epidermoid cysts.The objective was to determine the specific features of surgical treatment for each type of cysts of the chiasmo-sellar region, allowing to achieve the best postoperative results.Methods and materials. During the period from 2009 to 2018, 57 patients with cysts of the chiasmo-sellar region were examined and treated. All patients underwent transsphenoidal endoscopic treatment of cysts of the chiasmo-sellar region.Results. Among 57 operated patients, follow-up observation revealed only 2 relapses.Conclusion. For each type of cysts of the chiasmal-sellar region, there are specific features of surgical treatment that allow to achieve the best postoperative results.

Management of pineal and colloid cysts

The widespread use of MRI has led to the increasingly frequent diagnosis of pineal and colloid cysts. While most are small and incidental, do not require long-term monitoring and will never need treatment, they are a cause of patient anxiety and clinician uncertainty regarding the optimal management—particularly for larger cysts or those with an atypical appearance. Occasionally pineal cysts, and more commonly colloid cysts, cause hydrocephalus that requires urgent neurosurgical treatment. More recently the non-hydrocephalic symptomatic pineal cyst has been described in the neurosurgical literature but there is controversy over this entity and its management. This review addresses the difficulties in managing pineal and colloid cysts and provides a pragmatic framework for the practising clinician.

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

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.