Colloid cysts are benign intraventricular lesions that may present with a variety of neurologic symptoms, most commonly headache from obstructive hydrocephalus. The author discusses the clinical presentation, diagnosis, and management of colloid cysts. In particular, data regarding management of asymptomatic colloid cysts as well as comparison of risks/benefits of different surgical techniques are discussed.
• Incidentally discovered colloid cysts, particularly those less than 7 mm in diameter and without evidence of hydrocephalus, are at low risk for sudden deterioration.
• Microsurgical resection of colloid cysts on average results in a higher percentage of complete resection and decreased recurrence rates compared to endoscopic approaches.
• Overall morbidity is decreased with endoscopic resection compared to microsurgical resection.
Historical note and terminology
Colloid cysts are benign intraventricular lesions, usually arising in the third ventricle and consisting of collagenous capsule with a thick gelatinous, viscous material inside (Abdou and Cohen 1998). In 1858, Wallman described the first case of a colloid cyst presenting with urinary incontinence and ataxia (Wallman 1858). Dandy first successfully removed a colloid cyst in 1921 using an approach through the posterior right lateral ventricle. An early operative mortality of 20% was discouraging. Subsequently, transcallosal, transventricular, transcallosal interfornicial, transventricular subchoroidal, and stereotaxic approaches have all been successfully used to remove these lesions (Dandy 1933; Kelly 1951; Bosch et al 1978; Shucart and Stein 1978; Antunes et al 1980; Apuzzo et al 1982; Lavyne and Patterson 1983). Further, the adoption of microsurgical techniques has reduced operative mortality to near zero (Bosch et al 1978).
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