Hemorrhagic colloid cyst of the third ventricle: A rare cause of colloid cyst growth and progressive hydrocephalus. Case report / Quiste coloide hemorrágico del tercer ventrículo: una causa rara de crecimiento de los quistes coloides e hidrocefalia progresiva. Reporte de un caso

Introduction Acute spontaneous bleeding within a colloid cyst of the third ventricle is extremely rare. Accordingly, is difficult to establish reliable prognostic factors, risk factors for obstructive hydrocephalus remain poorly defined, and there are no standard management strategies. Case presentation 19-Year-old man with a colloid cyst of the third ventricle causing obstructive hydrocephalus is described, initially treated with partial endoscopic removal and ventriculo-peritoneal shunt placement. Serial neuroimaging follow-up showed gradual growth of the cyst due to clinically silent intracystic recurrent hemorrhage. Microsurgical transcallosal approach was performed and the cyst was totally resected. Pathological examination demonstrated hemorrhages of varying ages within the tumor. Conclusion Bleeding within a colloid cyst must be considered when neuroimaging follow-up shows cyst growth, even with no clinical events associated. Hemorrhagic changes within the colloid cyst should be considered in the surgical indication and approach. Resumen Introducción El sangrado espontáneo agudo en un quiste coloide del tercer ventrículo es extremadamente raro. En consecuencia, es difícil establecer factores pronósticos fiables, los factores de riesgo asociados a hidrocefalia obstructiva permanecen mal definidos y no existen estrategias de manejo estandarizadas. Presentación del caso Varón de 19 años con un quiste coloide del tercer ventrículo e hidrocefalia obstructiva, inicialmente tratado mediante extirpación endoscópica parcial y derivación ventriculoperitoneal. Posteriormente se demostró el crecimiento gradual del quiste debido a hemorragias intraquísticas recurrentes, clínicamente silentes. Se realizó un abordaje microquirúrgico transcalloso con resección completa. El examen anatomopatológico demostró la presencia de hemorragias en diferentes estadios dentro del tumor (AU)

Colloid cysts are rare and benign intracranial tumors located in the third ventricle. Reliably defining the natural history of colloid cysts has been challenging due to their low incidence and the small number of cases in most reported series. They are a well-known cause of obstructive hydrocephalus, with occasional rapid clinical deterioration, and even sudden death.1 Acute spontaneous bleeding within a colloid cyst of the third ventricle is a rare event usually causing a sudden increase of the cyst size, that results in obstructive hydrocephalus and clinical deterioration. This complication has only been reported in a few cases of the scientific literature.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 For these reasons, risk factors for obstructive hydrocephalus in the setting of hemorrhagic colloid cysts remain poorly defined, there are no grading scales on which to develop standardized management strategies and is difficult to establish the reliable prognostic factors and surgical indications. We report a case of a colloid cyst of the third ventricle, that, after partial endoscopic removal developed progressive gradual growth due to recurrent and initially silent intracystic hemorrhages. The literature of this rare entity has been revised (AU)

Hemorrhagic colloid cyst of the third ventricle: A rare cause of colloid cyst growth and progressive hydrocephalus. Case report.

INTRODUCTION: Acute spontaneous bleeding within a colloid cyst of the third ventricle is extremely rare. Accordingly, is difficult to establish reliable prognostic factors, risk factors for obstructive hydrocephalus remain poorly defined, and there are no standard management strategies. CASE PRESENTATION: 19-Year-old man with a colloid cyst of the third ventricle causing obstructive hydrocephalus is described, initially treated with partial endoscopic removal and ventriculo-peritoneal shunt placement. Serial neuroimaging follow-up showed gradual growth of the cyst due to clinically silent intracystic recurrent hemorrhage. Microsurgical transcallosal approach was performed and the cyst was totally resected. Pathological examination demonstrated hemorrhages of varying ages within the tumor. CONCLUSION: Bleeding within a colloid cyst must be considered when neuroimaging follow-up shows cyst growth, even with no clinical events associated. Hemorrhagic changes within the colloid cyst should be considered in the surgical indication and approach.

Spinal extradural arteriovenous fistula with intradural drainage: three surgical cases with long-term follow-up.

Spinal extradural arteriovenous fistulas (SEDAVF) with intradural drainage are uncommon vascular lesions that cause venous congestive myelopathy. We present three SEDAVF with intradural drainage treated with surgical disconnection of the intradural drainage via a single level laminectomy, followed by transarterial embolization (TAE) with Onyx if spontaneous thrombosis of the extradural fistula did not occur spontaneously. All patients improved their neurological condition and no congestive myelopathy recurrence was noted after mean follow-up of 84 months. We believe that SEDAVF with intradural drainage constitute a specific entity that should be included in the classifications of spinal arteriovenous malformations.