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  • Updated 05.01.2022
  • Released 03.25.1996
  • Expires For CME 05.01.2025

Colloid cysts

Introduction

Overview

Colloid cysts are benign intraventricular lesions most commonly located in the third ventricle that may present with a variety of neurologic symptoms, usually headache from obstructive hydrocephalus. However, some patients may be asymptomatic, and these may be incidentally discovered during routine radiological evaluation. The clinical presentation, diagnosis, and management of colloid cysts are outlined. In particular, data regarding management of asymptomatic colloid cysts as well as comparison of the risks and benefits of different surgical techniques are discussed.

Key points

• Incidentally discovered colloid cysts, particularly those less than 7 mm in diameter and without evidence of hydrocephalus, are at low risk for sudden deterioration.

• Conservative management is a viable treatment option because data reveal that some colloid cysts can regress spontaneously.

• 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 (01). In 1858, Wallman described the first case of a colloid cyst presenting with urinary incontinence and ataxia (80). 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 (21; 40; 11; 70; 03; 05; 46). Further, the adoption of microsurgical techniques has reduced operative mortality to near zero (11). Endoscopic resection of the colloid cyst was first reported in 1982, and it has lower postoperative morbidity and complications than microsurgical treatment (64; 67).

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