Colloid cysts of the third ventricle

Summary Colloid cysts of the third ventricle can cause hydrocephalus if they grow to the point where they occlude the foramina interventricularia. The operative approach via a craniotomy used to be the common method of treating these lesions. Now, in the era of CT- and MR-scanning, stereotactic aspiration should be preferred as an ideal method of simultaneously diagnosing and treating colloid cysts. Unlike open surgery, aspiration of colloid masses poses hardly any risk for the patient. Ten cases successfully treated by this technique are presented.Dedicated to Prof. Dr. Friedrich Loew on the occasion of his 65th birthday and the 25th anniversary of the Homburg Neurosurgical University Clinic, which has been founded and built up by him.     

Colloid cysts of the third ventricle

Since computerized tomography scanning became available at the Division of Neurosurgery in July, 1979, 13 patients have undergone removal of colloid cysts of the third ventricle by transfrontal or transcallosal routes. Computerized tomography has increased the number of colloid cysts detected in the foramen of Monro during neurological diagnostic workups. The clinical and diagnostic aspects and changing concepts in the treatment of colloid cysts are reviewed.     

Colloid cysts — a review including 19 own cases

Between 1974 and 1987 19 patients harbouring colloid cysts of the third ventricle have been treated in our department. There were 12 male and 7 female patients with an average age of 34 years (ranging from 17 to 58). Eighteen of the 19 patients underwent direct microsurgical removal of the space occupying lesion using the transcortical-transventricular approach. One patient had placement of a ventriculoperitoneal shunt and declined further treatment. There were no deaths in the entire series and no permanent neurological deficits were observed postoperatively. Surgery was successful in unblocking CSF pathways in 12 patients; six patients required permanent CSF diversion. Considering the advantages and disadvantages of various surgical modalities for the treatment of the lesions we recommend the microsurgical removal of the colloid cyst using the transcortical-transventricular approach.     

Colloid cysts of the third ventricle in identical twins

A young man presented to our unit with a colloid cyst of the third ventricle. Following successful surgical treatment his parents expressed concern over the possibility of his identical twin brother having a similar cyst. After finding one other case of colloid cysts in identical twins in the world literature we arranged a magnetic resonance scan of the asymptomatic twin. We were sceptical, but much to our surprise the scan also showed a colloid cyst in the third ventricle. Familial colloid cysts of the third ventricle have been reported only rarely. This is the second account of third ventricular colloid cysts in identical twins reported in the world literature. We present case reports of the twins, discuss the world literature on familial colloid cysts and also the genetic implications.     

Colloid cysts of the third ventricle a review of 36 cases

Summary Thirty-six colloid cysts were treated from 1949 to 1983. There were 26 male and 10 female patients, ranging in age from 12 to 65 years old, 60% between 31 and 40 years. Headache or disturbed mental function was the most frequent complaint, papilloedema the most frequent sign.The patients were classified into 3 groups by symptoms and signs;Group I (17 patients): Headache, papilloedema and no neurological signs.Group II (6 patients): Fluctuating or progressive dementia.Group III: Twelve cases with classical features, episodic headache and drop attacks.One patient could not be classified in any of these groups.Seventeen of 36 patients were diagnosed by ventriculography, 19 patients were diagnosed by CT scan. CT scan was the most reliable diagnostic study, but was unavailable in the earlier part of the series.All patients have been operated by transventricular exposure of the right foramen of Munro with incision of the middle frontal gyrus in an antero-posterior linear manner.Twenty-five of 36 patients showed an excellent operative result, and nine had a good result, one of the 9 patients dying of an unrelated intracerebral haemorrhage 4 years after operation. Two patients had a poor result, characterized by memory loss and confusion. One of these died of an unknown cause 5 years after operation.     

Colloid cysts with and without ventriculomegaly: Role of intraoperative real-time ultrasound

Intraoperative real-time ultrasound was used to assist localization and surgical removal of colloid cysts in patients without ventriculomegaly. In the most commonly used surgical approach for removal of colloid cysts, dilated lateral ventricles can expedite the localization of lesions because, once entered surgically, a dilated ventricle offers more space near the foramen of Monro in which to work. Additionally, the enlargement of the foramen of Monro, seen with hydrocephalus, provides greater accessibility to the colloid cyst. In patients with symptoms related to intermittent obstruction of cerebral fluid flow but with normal-sized ventricles, the precise localization of the foramen of Monro and colloid cyst is more difficult and may result in unnecessary exploration/resection of brain. Using intraoperative ultrasound, the colloid cyst and adjacent anatomic structures can be clearly visualized regardless of ventricular size. Intraoperative ultrasonography has a unique role in the operative treatment of patients with colloid cysts and nondilated ventricles.     

Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography

A retrospective review of colloid cysts diagnosed from 1974 to 1986 emphasizes the presenting symptoms of these lesions, their surgical management, and the contribution of modern imaging techniques to their diagnosis and therapy. In this 12-year period, 84 patients (45 men and 39 women) had a colloid cyst diagnosed. The patients' mean age was 46 years (range, 7-82 years). Surgery was performed in 55 patients, 7 of whom had undergone prior surgery elsewhere. The surgical approaches used were transfrontal-transventricular, transcallosal, computer-assisted stereotactic aspiration and resection by stereotactic craniotomy, and shunting of cerebrospinal fluid without removal of the lesion. There was no operative mortality, but complications occurred in 15 patients (27%). Preoperative imaging showed hydrocephalus in 93% of the patients: severe in 43%, moderate in 36%, and mild in 14%. In the surgically treated group, the most common presenting symptoms were headache, change in mental status, ataxia, nausea and vomiting, visual disturbance, emotional lability/inappropriate affect, depersonalization, and hypersomnolence. Twenty-four patients for whom surgery was not recommended are being followed up closely. Most of these patients had normal ventricles. The symptoms in this group included headache, anxiety/nervousness, ataxia, memory impairment, visual disturbance, and seizures. Five autopsy cases of patients with colloid cysts were available during this period and were reviewed. Direct removal of colloid cysts can be accomplished with low morbidity and mortality, avoiding the frequent revisions and complications related to shunt procedures. There is a subgroup of colloid cysts that can be operated upon electively or followed up closely with serial imaging studies.     

Colloid cysts of the third cerebral ventricle. Computed x-ray tomography, MRI and stereotaxic puncture. Apropos of 9 cases

The authors report their experience with Colloid Cysts of the third ventricle (9 cases treated between 1983 and 1989). Eight of them were punctured using stereotactic approach; five cysts were completely evacuated and the patients are free of recurrence. In three cases, tapping was impossible or the cyst insufficiently evacuated and the patients were secondary operated on (open microsurgical approach). The last case was directly operated on. Colloid cysts cured by stereotactic puncture were all hypo or iso-dense at C.T. scan and had a diameter of more than 1 cm. All these cases have had a M.R.I. exploration and the image of the cyst was always the same increased T1 and T2 signal. Unfortunately, we did not have the opportunity to realize M.R.I. in colloid cysts of a small size and hyperdense at C.T. scan. These results can help to the indication of a stereotactic puncture at the first attempt in some well defined colloid cysts.     

Colloid solutions: a clinical update

Albumin, dextran, gelatin, and hydroxyethyl starch (HES) solutions are colloids that efficiently expand the circulating blood volume. The administration of colloids restores the intravascular volume with minimal risk of tissue edema in comparison with crystalloid solutions alone. However, colloids are always given for surgical and critically ill patients. The type of the colloid, volumes applied, aggressiveness of fluid resuscitation, and the volume status at the initial phase of administration determine their clinical responses. The outcome after fluid resuscitation with various colloids in critically ill patients seems to be comparable according to systematic reviews. A randomized, adequately powered clinical trial comparing modern nonprotein colloid to albumin is still lacking. Rapidly degradable HES solutions have good hemodynamic effects, and the risk of adverse renal and coagulation effects, as well as allergic reactions, is minimal. The current investigation has also shown the beneficial effect of HES solution (especially HES 130/0.4) on inflammatory response, postoperative nausea and vomiting, and postoperative outcome. The indication of colloids with an assessment of the degree of hypovolemia and safety profiles should thus be taken into consideration before colloid administration.     

Colloid solutions in the critically ill

All patients admitted to an Intensive Care Unit were assigned randomly to one of two groups, A and B. Group A received colloid volume replacement as 4.5% albumin whilst group B received a synthetic colloid, polygeline. This study describes the changes in serum albumin concentration in survivors and nonsurvivors in the two groups during their stay in the Intensive Care Unit. The incidences of renal failure and pulmonary oedema were also assessed. Serum albumin concentration decreased in all nonsurvivors. In survivors the serum albumin concentration decreased to a greater extent in the synthetic colloid group than in the albumin group. Despite the differences in serum albumin concentration there were no significant differences between the groups in the incidences of pulmonary oedema or renal failure.