Risk Analysis and Management of Third Ventricular Colloid Cysts.

OBJECTIVE: Colloid cysts (CCs) are histologically benign lesions that carry the risk of causing obstructive hydrocephalus. The indication for surgery for symptomatic cysts is unquestioned; however, the management of incidentally detected lesions has remained controversial. We independently evaluated the CC risk score (CCRS) as a useful risk stratification scheme. METHODS: The demographics, imaging characteristics, and clinical presentations of 103 patients with CC during a 10-year period were correlated with symptoms and the occurrence of hydrocephalus. The discriminate capacity of the CCRS was quantified and a decision algorithm formulated. RESULTS: The correlates of symptoms included age <65 years, diameter ≥7 mm, anterior location, hyperintensity on T2-weighted fluid-attenuated inversion recovery (FLAIR) and/or T2-weighted images, and headache at presentation without an alternative explanation. On multivariate analysis, age <65 years, diameter ≥7 mm, and headache at presentation predicted for symptomatic cysts. The CCRS was highly effective at identifying symptomatic patients and those with obstructive hydrocephalus. All patients with cyst growth and symptomatic progression had had an initial CCRS of ≥3 plus hyperintensity (preexisting or developing) on T2-weighted FLAIR images. CONCLUSIONS: The CCRS performed exceptionally well in distinguishing the highest risk patients. Closer follow-up is recommended for younger asymptomatic patients with cysts near the foramen of Monro. Hyperintensity on T2-weighted FLAIR images might indicate greater growth potential for small lesions.

The Case of the Disappearing Colloid Cyst.

BACKGROUND: The natural history of colloid cysts is imperfectly understood, and controversies remain in defining broad management strategies for incidental colloid cysts. The gradual asymptomatic regression of a colloid cyst has not been reported. CASE DESCRIPTION: We present a unique case demonstrating the clinically silent, gradual regression of a colloid cyst over many years. CONCLUSIONS: Gradual regression of a colloid cyst is possible. The philosophical and practical implications of this case on the neurosurgeon's approach to managing patients with colloid cysts are discussed.

Solitary Primary Central Nervous System Lymphoma Mimicking Third Ventricular Colloid Cyst-Case Report and Review of Literature.

BACKGROUND: Primary central nervous system lymphoma is a rare malignant tumor of the central nervous system. It is associated with poor prognosis and accounts for 0.7%-0.9% of all lymphomas and only 0.3%-1.5% of intracranial tumors. Typically, these lesions are in the cerebral white matter near the corpus callosum, the central gray matter, the basal ganglia-thalamus-hypothalamic region, the posterior fossa and the periventricular region. Only 2 cases with pure third ventricular lymphoma have been reported in the literature. CASE DESCRIPTION: A 72-year-old female patient known to have type II diabetes mellitus treated with insulin, hypertension, chronic kidney disease, dyslipidemia, and obesity presented with a history of acute confusion and urinary incontinence. No headache was reported on admission, but previously she had intermittent mild headaches and generalized body aches. She had no history of visual symptoms. Her family said she was mildly confused and had memory difficulties that started acutely 2 days before presentation to the hospital. The patient had urgent computed tomography of the brain, which showed a hyperdense lesion in the region of the foramen of Monro. Pre-operative images diagnosed the case as colloid cyst, but post-operative histopathology proved the lesion to be primary CNS lymphoma. CONCLUSIONS: Eleven months after surgery, the patient is fully consciousness and oriented, with no memory issues or neurologic deficit. She is back to her baseline activities. We are reporting this case for the rarity of the disease and the unusual location of it.

An unusual location and presentation of a usual pathology-Colloid cyst of fourth ventricle presenting as spontaneous rhinorrhea.

Colloid cysts are relatively rare benign intracranial lesions preferentially located within the third ventricle. There are only a few reports in which they have been found to be ectopic, such as in the fourth ventricle. A young female presented on with spontaneous non-traumatic cerebrospinal fluid (CSF) rhinorrhoea for three months which was positional in nature, relieved temporarily by neck flexion. Magnetic resonance imaging (MRI) scan showed a focal well-defined rounded cystic lesion along the fourth ventricle, showing subtle peripheral rim enhancement. Significant hydrocephalus was also noted. A suboccipital craniotomy and total excision of the lesion was done. Postoperatively, the patient recovered quickly with no neurological deficits. Her rhinorrhoea was completely cured. Histopathology was consistent with a colloid cyst. Colloid cyst is rarely found in infratentorial location. However, such a rare diagnosis has to be considered in the differential diagnosis in patients who present with an infratentorial cystic lesion associated with spontaneous CSF rhinorrhoea.

An unusual presentation of colloid cyst--implications for lifestyle advice.

Colloid cysts are rare intracranial neoplasms which typically present with headaches. There is risk of neurological deterioration or death due to acute hydrocephalus. We report a case of colloid cyst presenting after a sudden acceleration/deceleration force from a theme park ride, highlighting the importance of lifestyle advice in these patients.

Microsurgical excision of colloid cyst with favorable cognitive outcomes and short operative time and hospital stay: operative techniques and analyses of outcomes with review of previous studies.

OBJECTIVE: Microsurgical and endoscopic colloid cyst excision differ with regard to operative time, length of hospital stay, and extent of resection. METHODS: A retrospective review of a single surgeon's microsurgical colloid cyst resection in 10 consecutive patients was performed. Cyst size, hydrocephalus, symptoms, operative time, postoperative stay, complications, and objective testing of memory, concentration, calculation, and attention (cognition), along with performance at job, were noted. RESULTS: All 10 patients had complete excision. Mean cyst size, mean operative time, and median postoperative stay were 1.6 cm, 124 minutes, and 3.5 days respectively. The mean operative time from cyst visualization to complete excision was 18 minutes. Follow-up ranged from 6 to 111 months (mean, 49.5 months). There were no recurrences; symptoms (headache, visual and balance problems) improved significantly in 70%. Postoperative cognitive performance, including memory, was the same in 8 patients (5 of whom had preoperative memory problems) and worse in 2 patients who had no preoperative memory problems. The bone flap was removed in 1 patient for wound dehiscence. Hemiparesis in another patient, seen immediately after surgery, completely resolved before discharge. One patient with loculated ventricles and multiple previous shunt revisions had unresolved hydrocephalus after cyst excision. CONCLUSION: We report the very short operative times and postoperative stay for microsurgery, which are comparable to some endoscopic series. We also report results of objective tests of cognitive performance. With adoption of a callosal incision of 1 cm or less, meticulous dissection around the fornix, and complete excision, acceptable long-term cognitive function and functional performance were achieved. Our results support the microsurgical approach. A larger sample size can more conclusively establish whether it should be chosen over the endoscopic technique.