Clinical Neurology and Neurosurgery 209 (2021) 106951 Available online 16 September 2021 0303-8467/© 2021 Elsevier B.V. All rights reserved. Colloid cysts: Neuropsychological outcome, quality of life and long-term control after endoscopic gross total resection Sivashanmugam Dhandapani a, * , Rajat Verma a , Manju Mohanty a, c , Anchal Sharma a , Sameer Vyas b , Manju Dhandapani c , Sunil K. Gupta a a Department of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India b Department of Radiology Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India c NINE, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India A R T I C L E INFO Keywords: Colloid cyst Neuropsychology QOL Endoscopy Outcome Microsurgery VP shunt GTR Memory ABSTRACT Background: Endoscopy is increasingly being adopted for removing colloid cysts. However, the neuropsycho- logical outcome and quality of life (QOL) have not been studied in detail. This study is to evaluate the effcacy of endoscopic excision on cognitive measures and QOL. Methods: Patients with colloid cysts larger than 7 mm, undergoing endoscopy were prospectively studied con- cerning clinico-radiology, cognitive parameters (age and education adjusted), extent of resection and recurrence. A cross-sectional QOL assessment was additionally performed on endoscopic patients in comparison with cases who underwent microsurgery or standalone ventriculo-peritoneal (VP) shunt. Results: A total of 22 endoscopic patients with a mean age of 34 years and a mean cyst diameter of 19 mm were studied. Gross total resection(GTR) could be achieved in all. Over a mean follow-up of 53.4 months, none had a recurrence, ventriculomegaly, or retreatment. Among neuropsychological parameters, digit span was the most affected before surgery. There was a broad-based improvement in the mean global cognitive score from 40.63 (±10.4) at baseline to 50.25(±5.8) after endoscopy with maximum improvement in ’immediate recall.’ The change in scores also had a signifcant inverse correlation with cyst size, with cysts larger than 18 mm, resulting in lower scores following endoscopy(R=0.9, P=0.01). QOL was signifcantly infuenced by visual and cognitive impairments and was better among endoscopic patients than similar microsurgery or VP shunt controls, with a signifcant difference in social and environmental domains(P=0.02). Conclusion: Endoscopy is effective in achieving GTR and long-term control, with neuropsychological improve- ment correlated with cyst size. This is probably the frst report to show QOL is infuenced by cognitive pa- rameters and is better following endoscopy than after microsurgery or VP shunt. Colloid cysts are epithelial lined benign cystic growths from ectopic endodermal elements close to the anterior third ventricular roof constituting 0.5–2% of intracranial tumors, or one in fve intraventric- ular tumors [1,2]. As more than 50% of patients become symptomatic by the time of diagnosis, carrying up to 38% risk of sudden death, surgical intervention is often recommended, except for asymptomatic patients with cysts smaller than 7 mm [2,3]. Mere aspiration or decompression of the cyst results in recurrence as high as 80%, necessitating complete excision of the cyst wall [4]. Microsurgical excision has been associated with more signifcant post- operative morbidity (16–19%) and readmissions due to seizures, infec- tion, venous infarction, or intracerebral hematoma [5–7]. Endoscopic surgery is gaining popularity in recent times for treating colloid cysts because of its minimal invasiveness [8]. However, there is a paucity of studies detailing the neuropsychological outcome, comparative effcacy on quality of life (QOL), and almost no study on the relationship be- tween the cognitive derangements and the QOL [9–11]. There are four questions concerning colloid cysts, which are yet to be answered decisively. First, how much are the neurocognitive impair- ments associated with 3rd ventricular colloid cysts? Second, is endos- copy suffcient for achieving gross total resection (GTR) and long-term control? Third, how does aggressive endoscopic resection of colloid cysts affect neuropsychological parameters? And fourthly, how better is the QOL among endoscopic patients than microsurgery or just * Correspondence to: Department of Neurosurgery. Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India. E-mail address: ssdhandapani.neurosurg@gmail.com (S. Dhandapani). Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro https://doi.org/10.1016/j.clineuro.2021.106951 Received 20 August 2021; Received in revised form 8 September 2021; Accepted 9 September 2021