Huge colloid cyst of the third ventricle associated with calcification in the cyst wall

Giant or huge colloid cysts of the third ventricle up to of more than 3 cm in diameter are extremely rare. The patient presented with symptoms of increased intracranial pressure, including headache, vomiting, and papilledema. Computerized tomographic (CT) scan revealed a hypodense, huge colloid cyst of the third ventricle associated with calcification in the cyst wall. Both hypodensity and calcification are uncommon roentgenological findings for colloid cysts of the third ventricle. The patient was operated on by the transcortical/transventricular approach and the colloid cyst was completely excised.     

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.     

Evaluation of brain injury after coronary artery bypass grafting. A prospective study using neuropsychological assessment and diffusion-weighted magnetic resonance imaging.

OBJECTIVE: Neurocognitive dysfunction is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Studies using magnetic resonance imaging (MRI) have demonstrated that new focal brain lesions can occur after coronary artery bypass grafting (CABG), even in patients without apparent neurological deficits. Diffusion-weighted MRI is superior to conventional MRI and allows for sensitive and early detection of ischemic brain lesions. We prospectively investigated cerebral injury early and 3 months after CABG using diffusion-weighted MRI and related the findings to clinical data and neurocognitive functions. METHODS: Twenty-nine patients [67.6+/-8.6 (52-85) years, 5 females] undergoing elective CABG with CPB were examined before surgery, at discharge and 3 months after surgery. A battery of standardized neuropsychological tests and questionnaires on depression and mood were administered. Conventional and diffusion-weighted MRI of the brain was performed and new lesions were analyzed. Clinical characteristics, neuropsychological test performance and radiographic data were collected and compared. RESULTS: There was no major neurological complication after CABG. Thirteen patients (45%) exhibited 32 new ischemic lesions on postoperative diffusion-weighted MRI. The lesions were small, rounded and equally dispersed in both hemispheres. Eight patients had at least two lesions. At discharge, significant deterioration of neuropsychological performance was observed in 6 of the 13 tests compared to baseline assessment. By 3 months postoperatively, 5 of the 6 tests returned to preoperative levels. Verbal learning ability, however, remained impaired. The presence of new focal brain lesions was not associated with impaired neuropsychological performance. There was also no correlation between clinical variables, intraoperative parameters and postoperative complications and MRI findings. CONCLUSIONS: Although neurocognitive decline after CABG is mostly transient, memory impairment can persist for months. New ischemic brain lesions on postoperative diffusion-weighted MRI do not appear to account for the persistent neurocognitive decline.     

Neuropsychological findings in patients with intraventricular tumors

BACKGROUND: Intraventricular tumors are quite rare and become symptomatic with hydrocephalus-related signs such as headache, double vision, and seizures. Also, most of the patients show neuropsychological deficits, especially memory problems and lack of attention. METHODS: We reviewed the charts and computed tomographic/magnetic resonance images of 15 patients with tumors of the lateral and third ventricle, who were also examined by a neuropsychologist pre- and postoperatively. Neuropsychological testing included tests of attention, memory, executive functions, and concentration. RESULTS: Between 1995 and 2003, 7 patients with colloid cysts of the third ventricle (3 men, 4 women; mean age, 38 years), 5 patients with meningiomas of the lateral ventricle (2 men, 3 women; mean age, 51 years), and 3 patients with astrocytomas and ependymoma (2 men, 1 woman; mean age, 38 years) were treated. All patients with colloid cysts and meningiomas showed mental changes, especially attention and memory deficits. Symptoms improved markedly after surgical intervention. The 3 patients with astrocytoma and ependymoma showed normal results pre- and postoperatively. CONCLUSION: Neuropsychological testing is very useful in patients with intraventricular lesions and important for follow-up examinations. It should be included in every workup examination in this small patient group.     

Endoscopic transchoroidal and transforaminal approaches for resection of third ventricular colloid cysts

To review our experience over 10 years in endoscopic resection of third ventricular colloid cysts, describing the details of the transventricular–transchoroidal approach used in selected patients. This series included 24 patients with colloid cysts of the third ventricle treated in our department between October 2001 and January 2013 using an endoscopic approach. Clinical presentation, preoperative radiological findings, endoscopic technique employed, and complications were assessed in all patients. The mean length of patient follow-up was 5.16 years. The most common symptom was headache (75 %). The average size of the resected colloid cysts was 16.25 mm, the maximum diameter measured in cranial magnetic resonance imaging. Resection was transforaminal in 16 cases (66.7 %), transchoroidal in 7 (29.17 %), and transseptal in 1; macroscopically complete resection was achieved in 23 of 24 procedures (95.8 %). Complications included three intraventricular hemorrhages, four memory deficits (two of them transient), one case of temporary potomania, two soft tissue infections, and one meningitis. There were no statistically significant differences between the route of resection and number of complications. The Glasgow Outcome Scale at 1 year after surgery was 5 in 82.6 % of the patients. A transventricular endoscopic approach allows macroscopically complete resection of third ventricle colloid cysts in most cases. The option of opening the choroidal fissure (transventricular–transchoroidal approach) during the procedure can address third ventricle colloid cysts that do not emerge sufficiently through the foramen of Monro without increasing procedure-related morbidity.     

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

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.     

Tumors of the third ventricle: review of 262 cases

The data from 262 cases of third ventricle (V3) tumors treated in 21 Departments of Neurosurgery in France between 1980 and 1995 were collected in this series. These tumors were frequent in young adults, and 17.5% of the patients were children. Colloid cysts (55%) and gliomas (19%) were the most frequent lesions. Other tumors were rare, or exceptional. CLINICAL PRESENTATION: The duration of symptoms was short in time, despite these lesions were usually benign. Most of cases were revealed by intracranial hypertension (63%), sometimes with a paroxystic or positional evolution. Neuropsychological signs (48 %) were undoubtedly under-estimated, revealing the disease in only 10% of cases. Ophthalmologic signs and endocrine disorders were infrequent. This feature is related to the selection of patients in this series, as tumors arising from the floor of the third ventricle or from the optic chiasm were excluded. Endocrine disorders were frequent with gliomas (30 %). THERAPEUTIC MANAGEMENT: In half of the patients, hydrocephalus was absent or mild and was ruled out after the treatment of the ventricular lesion. However, 12% of patients required a shunt procedure after the treatment of the ventricular lesion. A stereotactic procedure was performed in 63 patients, 12 had ventriculoscopy, and a direct surgical approach to the V3 was performed in 200 patients, sometimes after the failure of stereotactic or endoscopic procedures. Thirty six patients received no treatment. The patients were operated on via a transcortical approach (159 cases), or via the anterior transcallosal route (35 patients). Postoperative course was uneventful in 67% of the patients, complications were recorded in 24% of patients. MORTALITY AND MORBIDITY: The overall mortality in the national series is 13.7 % (36/262 died). The death occurred before any treatment (4 patients), or was directly correlated to the surgical procedure (13 cases), to long-term complications of hydrocephalus (2 patients), to general complications (7 patients), or to recurrence of the tumor (10 cases). The final outcome analysis recorded neurological impairment in 29% of cases, neuropsychological deficit in 50% of patients, and residual endocrine disorders in 19%. Social independence was recovered by 86% of patients, 76% of them returned to work, 72% of students returned to normal school attendance. The long-term neurological outcome was better with the transcallosal approach. No conclusion was possible concerning neuropsychological outcome, as postoperative neuropsychological assessment was not available for most of the patients operated on with the transcortical approach. PROGNOSIS: The results of treatment were evaluated only for the most frequent lesions (colloid cysts and gliomas). The outcome was worse for gliomas when compared to colloid cysts, considering mortality (13% vs 8%), neurological impairment (36% vs 21%), residual endocrine disorders (34% vs 0%), and ability to return to work (83% vs 56%).     

Infratentorial supracerebellar approach to the colloid cysts of the third ventricle

OBJECTIVE: The transcallosal and the frontal transcortical approaches are the most widely used methods in surgery of third ventricle colloid cysts. However, these approaches require traction of the frontal lobe and dissection of the corpus callosum or corticotomy and involve some postoperative consequences. The rationale of the proposed method is to remove the colloid cyst by the infratentorial supracerebellar approach and the posterior wall of the third ventricle without dissection of any neural structures. METHODS: Five patients with a colloid cyst of the third ventricle were operated on by the proposed method. The first patient presented with several months' history of symptoms that included increased intracranial pressure and right-sided cerebellar signs, caused by a metastatic tumor of the right cerebellar hemisphere. The other four patients had symptoms including intracranial hypertension for an extended period of time without any other neurological deficits. In all patients, magnetic resonance imaging revealed a colloid cyst of the third ventricle without hydrocephalus. TECHNIQUE: With the infratentorial supracerebellar approach, the arachnoid of the quadrigeminal cistern is dissected. The pineal body is separated and displaced from the internal vein medially, and the posterior velum interpositum is opened. Perforation of the inferior layer of the tela choroidea just above the suprapineal recess allows opening of the third ventricle cavity. A foraminal region is exposed after a slight lateral displacement of medial surfaces of the thalamus along the third ventricle roof. CONCLUSION: The proposed approach through the infratentorial supracerebellar space and the posterior wall of the third ventricle may be used for removal of colloid cysts, especially in patients in whom the lateral ventricles are not enlarged.     

Neuropsychological Follow-up of Twenty Two Adult Patients After Surgery for Craniopharyngioma

Summary  The optimal management of craniopharyngioma today remains an unconcluded debate. This prospective study examines the cognitive status and quality of life of 22 patients one year after surgery for craniopharyngioma.  Pterional approach (5 left, 15 right) was used in 20 patients (90%), whereas two were operated on using a rhinoseptal approach.  Neuropsychological examination was performed twelve months after the operation. For twelve patients, neuropsychological examination was performed before operation.  The preoperative evaluation revealed that six patients had impaired neuropsychological testing with memory and frontal dysfunction. Four of these patients have no postoperative neuropsychological defect.  After surgery, there were 5 patients in whom abnormalities could be detected on the extended psychometric assessment: two were severe (a Korsakoff's syndrome and a memory defect associated with an intellectual deterioration), and three moderate (recent memory defects with frontal dysfunction, isolated learning defects). Four patients of the 22 were not able to return to their pre-illness activity.  The present evaluation emphasizes that a good quality of life and neuropsychological performance were maintained in the majority of patients. Preoperative frontal dysfunction is probably correlated to tumour location, and precisely to the interruption of the direct efferent projections from the frontal cortex to the hypothalamus.  Postoperative alterations of neuropsychological function were noticed only in patients with pterional approach. These patients had a poor surgical outcome, preoperative neuropsychological defects or treatment combined with radiotherapy. The two patients who were operated on using a rhinoseptal approach had no neuropsychological deficit. But this surgical approach is best reserved for patients with smaller intrasellar tumours. Further studies are needed to evaluate the neuropsychological advantage of these different approaches.     

Stereotactic management of colloid cysts: factors predicting success

Stereotactic aspiration is a valuable surgical alternative for colloid cysts when used alone or in conjunction with microsurgical resection. Since 1981, the authors have performed computerized tomography (CT)-guided stereotactic aspiration as the initial procedure in 22 patients with colloid cysts; stereotactic aspiration alone was successful in 11 patients (50%). Of the 11 patients in whom aspiration failed, stereotactic endoscopic resection was attempted in three and was successful in one. Seven patients required a craniotomy and microsurgical removal of the cyst performed via a transcortical approach. The preoperative CT appearance in eight cases of a hypodense or isodense cyst correlated favorably with successful aspiration of the cyst in six patients. A hyperdense appearance on the preoperative CT scan in 14 cases was associated with subtotal aspiration in 13 patients; five required craniotomy for removal. Preoperative magnetic resonance (MR) imaging in eight patients provided excellent anatomical definition of the cyst and its relationship to other structures of the third ventricle, but it was not possible to correlate successful aspiration with cyst appearance on MR images with short or long relaxation time sequences. The authors' 9-year experience suggests that preoperative CT studies accurately determine size, predict viscosity, and help to define a group of colloid cyst patients for whom stereotactic cyst aspiration will likely be successful. Unsuccessful stereotactic aspiration was related to two features: the high viscosity of the intracystic colloid material (nine patients), or deviation of the cyst away from the aspiration needle due to small cyst volume (two patients). Because of its simplicity and low risk, stereotactic surgery can be offered to selected patients as the initial procedure of choice. Craniotomy can be reserved for those whose imaging studies predict failure or for those whose cyst cannot be aspirated.     

Stereotaxic diagnosis and treatment of colloid cysts of the 3d ventricle. Apropos of 7 cases

The clinical and anatomical results of the treatment of 7 colloid cysts of third ventricle by stereotaxic aspiration are reported. A history of increased intracranial pressure was reported in all patients (4 females aged of 12, 16, 28, 38 years; 3 males aged of 36, 54, 59 years). A ventricular shunting device has been inserted in 4 patients. Pre-operative clinical findings were: signs of increased intracranial pressure (1 case), isolated memory disturbances (3 cases); motor weakness, memory disturbances and psychomotor slowness (2 cases); 1 of the 2 last cases had also thymic disturbances. Clinical examination was normal in 1 patient. CT-Scan revealed 5 hyperdense lesions, 3 with slight enhancement; 1 hypodensity encircled by an hyperdense ring without enhancement, 1 not enhancing isohypodensity. 6 colloid cysts were between the Foramens of Monro, 1 in the posterior third ventricle. Cyst volume ranged from 1.8 to 6.3 cc. (m: 3.4). Biventricular hydrocephalus was present in all but 1 patient. Stereotaxic aspiration of the cyst performed according to Talairach's system resulted in a release of C.S.F. circulation in all cases. 3 colloid cysts were aspirated completely, 4 were reduced to 3%, 11%, 12%, 33% of the initial volume. Post-operatively 2 patients presented with a transient meningeal reaction, 1 with a transient "myoclonic" syndrome. In 1 "completely aspirated" case a control CT-Scan showed, 5 years later, a small hyperdensity corresponding to 4% of the initial cyst volume. All patients lead a normal and useful life (Follow-up: 8-78 months, m: 45). Neurological examination is normal in 6 cases and shows a pre-existent facial asymmetry in 1. Ours results suggest that stereotaxic investigation should be the first safe procedure in order to achieve both diagnosis and treatment of colloid cysts of third ventricle.     

A new protocol for training severely impaired patients in the usage of memory journals

Although memory disorders are frequently seen in survivors of brain injuries, remediation of patients with severe memory disorders is still relatively neglected in clinical practice due to pessimism by clinicians regarding the efficacy of such remediation. With respect to memory journal training, a further reason for this neglect is likely the lack of readily accessible protocols that therapists can use to work with these patients. The purpose of the present paper is to describe a new memory journal training protocol that was developed to teach brain injury survivors how to compensate for severe memory impairments by using three strengths of most brain injury survivors: immediate attention, procedural memory, and old learning. A training protocol is described that involves baseline testing and a needs assessment, five levels of training exercises, and discharge probe testing. It is concluded that patients with severely impaired memory abilities can learn the present system when care is taken to individualize journals, conduct proper needs assessments, and provide structured training exercises geared to the strengths of memory impaired persons.     

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.     

Changing concepts in the treatment of colloid cysts. An 11-year experience in the CT era

Since computerized tomography (CT) scanning became available at the University Health Center of Pittsburgh in July, 1975, 17 patients have undergone removal of colloid cysts of the third ventricle by transfrontal, transcallosal, or stereotaxic surgery. All patients presented with symptoms and signs of increased intracranial pressure; CT scanning proved to be the best neurodiagnostic test to define the colloid cysts. Since the development of CT-guided stereotaxic surgery, the authors have preferentially performed stereotaxic aspiration in seven patients; three of these subsequently required craniotomies to remove residual cysts producing persistent symptoms. The viscosity of the intracystic colloid material and/or displacement of the cyst away from the aspiration needle were reasons for unsuccessful aspiration; the CT appearance did not correlate with the ability to aspirate the lesion by the sterotaxic technique. Postoperative patency of the ventricular system was documented by intraoperative CT ventriculography performed during stereotaxic surgery. Removal of the cyst wall was not necessary. Because of the low associated morbidity rate, percutaneous stereotaxic aspiration is recommended as the initial treatment of choice for colloid cysts of the third ventricle. If stereotaxic aspiration fails and symptoms persist, craniotomy should be performed.     

Endoscopic treatment of colloid cysts of the third ventricle: long-term results in a series of 6 consecutive cases

AIM: Colloid cysts of the third ventricle represent 0.5-2% of all intracranial tumors. Several surgical approaches have been proposed for the treatment of these lesions and endoscopy is the most recent one, but the best treatment still remains controversial. We decided to treat colloid cysts with endoscopic approach since 1999. In this paper we present our results in 6 consecutive cases admitted at our institution from 1999 to 2004. METHODS: There were 4 males and 2 females. The mean age was 51.6 (range 29-77). All the cysts were symptomatic. The presenting symptom was headache in 4 patients, gait disturbance in 2, altered vision in 2, mental status change in 2, urinary incontinence in 2, loss of consciousness in 2 and short-term memory loss in 1 patient. All the endoscopic procedures were performed via a right precoronal burr hole, with a rigid endoscope. RESULTS: The removal was radiologically complete in 4 cases and incomplete in 2. Overall outcome was good in all cases, with an improvement of colloid cyst-related hydrocephalus in all the patients. There was no surgical mortality. The mean follow-up period was 52.5 months. No tumor recurrences were observed. Complications occurred in only one patient: a septic ventriculitis, venous thrombosis of the right leg and pulmonary embolism developed, but completely resolved during the hospitalization time. CONCLUSION: The endoscopic approach for the removal of colloid cysts of the third ventricle represents a safe procedure, and can be considered a very good option for the treatment of these lesions.     

Surgical management of colloid cyst of the third ventricle--a study of 105 cases

BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised. METHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up. RESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally.Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised. CONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.     

High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle

OBJECT: Patients harboring colloid cysts of the third ventricle can present with acute neurological deterioration, or the first indication of the lesion may appear when the patient suddenly dies. The risk of such an occurrence in a patient already identified as harboring a colloid cyst is unknown. The goal of this study was to estimate the risk of acute deterioration in patients with colloid cysts. METHODS: A retrospective study was made of a cohort of patients with newly diagnosed colloid cysts who were recruited in The Netherlands between January 1, 1993, and December 31, 1997. Seventy-eight patients were identified, all of whom displayed symptoms. Twenty-five patients (32%) presented with symptoms of acute deterioration; four patients died suddenly and the cysts were discovered at autopsy. The overall mortality rate was 12%. Results of a multivariate logistic regression analysis demonstrated that no subgroup of patients presenting without acute deterioration could be identified on the basis of patient age, duration of symptoms, cyst size, or the presence of hydrocephalus. The national incidence of colloid cysts in The Netherlands is 1/10(6) person-years; the prevalence was estimated to be 1800 asymptomatic colloid cysts. CONCLUSIONS: Acute deterioration was a frequent presentation among a national cohort of Dutch patients harboring symptomatic colloid cysts. The risk of acute deterioration in a symptomatic patient with a colloid cyst in The Netherlands is estimated to be 34%. The estimated risk for an asymptomatic patient with an incidental colloid cyst is significantly lower. These results strongly advocate the selection of surgical treatment for patients with symptomatic colloid cysts.     

Endoscopic surgery of third ventricle lesions

The endoscopic approach of the tumors of the third ventricle interests mainly the colloid cysts but also offers the possibilities of biopsies. Twenty two patients (16 men and 6 women, average age 41 years) presenting with hydrocephalus related to a tumor of the pineal area were treated by a ventriculostomy with attempt at biopsy : they are outside of the limits of this report. Twenty two other patients (15 men, 7 women, average age 39 years) were operated on from 1994 to 1999 for a colloid cyst, and 2 of them were admitted in emergency in sudden coma. The CT scan showed a colloid cyst (hyperdense in 16 patients) associated with an hydrocephalus, except for a patient previously shunted. The diameter of the cyst varied from 4 to 50 mm (average of 20 mm). All the patients were operated on using a rigid endoscope. Among the 20 patients presenting a tumor of the pineal area, a biopsy was possible only in 4 cases (20%). There were no hemorrhage nor neurological disorders. In all the cases, the size and the number of the specimens were sufficient to allow the histological diagnosis. For the patients presenting with colloid cyst, the average follow-up is 2 years. All the preoperative symptoms disappeared except for the memory disorders which were improved. The post-operative Evans index decreased significantly. No residual cyst was observed on the post-operative MRI in 14 patients (63%). Among these patients, an asymptomatic recurrence was observed and remained stable after 44 months of follow-up. A residual cyst was observed in 8 patients (36%), with a diameter from 5 to 25 mm (average 9 mm). No patient required a shunt procedure, and no patient presented hemorrhagic complication. Endoscopy is especially useful in the first line treatment of the colloid cysts of the third ventricle.     

Hemorrhagic colloid cyst: case report and review of the literature

Colloid cysts are benign tumors situated in and connected to the roof of the third ventricle. The clinical presentation is diverse, varying from incidentally found cysts to acute death. This presentation is explained by an acute hydrocephalus due to an obstruction of the cerebrospinal fluid (CSF) flow at the level of the foramina of Monro. Why these lesions cause a sudden obstruction is not clear in most cases. Possible explanations of a sudden deterioration are shifts of the cysts after lumbar puncture or CSF flow obstruction after shunt dysfunction. We add an explanation for the acute deterioration of patients with colloid cysts (ie, hemorrhagic changes in the cysts). This complication has been published only 4 times before, all diagnosed at postmortem examination. A young patient is presented with a recently diagnosed and symptomatic colloid cyst who deteriorated the night before surgery because of intracystic hemorrhage. Despite emergent CSF diversion, our patient remained in a poor clinical condition. We review the literature about this topic and discuss the consequences for the neurosurgical practice.     

氯胺酮对发育早期小鼠学习记忆及脑源性神经营养因子表达的影响

目的观察氯胺酮对发育早期小鼠学习记忆能力及脑源性神经营养因子(BDNF)表达的影响。方法取14日龄昆明小鼠50只随机均分为五组:腹腔注射氯胺酮25mg/kg(K1组)、50mg/kg(K2组)、100mg/kg(K3组);生理盐水组(N组),腹腔注射等容生理盐水,每日1次,连续7d;正常对照组(C组)不注射任何药物。在实验第8、9天用跳台法测定小鼠的学习记忆能力,测定结束后取海马测定BDNF的表达。结果与C组比较,K1组学习潜伏期延长、错误次数增加(P<0.05),N组错误次数增加(P<0.01),BDNF的表达减少(P<0.05)。结论反复腹腔注射氯胺酮有可能损害发育早期小鼠的学习记忆能力,BDNF表达的减少有可能是其介导因素。