Endoscopic Resection of Colloid Cysts: Surgical Considerations Using the Rigid Endoscope W esley A. King, M .D., Jamie S. Ullman, M .u ., John G. Frazee, M .D., Kalmon D. Post, M .D ., Marvin Bergsneider, M.D. Department of Neurosurgery (WAK, JSU, KDP), Mount Sinai Medical Center, New York, New York, and Division of Neurosurgery (JGF, MB), University of California, Los Angeles, Medical Center, Los Angeles, California BIECTIVE: Colloid cysts of the third and lateral ventricular endo- r ^ lS itT a lfb lr u ^ e T ^ e a , S ,h«e lesions. Our study was undertaken to examine the eff.cacy o, rigid endoscopy in the resection of colloid cysts. were given the option of undergoing either IETHODS: Fifteen patients with a radiological . wag 1 43 cm fourteen patients underwent planned endoscopic surgery or craniotomy. T e average initially in one patient. . endoscopic resections, and a craniotomy was p . e in 12 patients (86%). A craniotomy was required ESULTS: Entire tumor resection was achieved wi ln tota|, complete radiographic resections were for two colloid cysts that could not be reseC^ed entPcomp|iCations, although postoperative deficits included achieved in 14 patients (93%). There were p natient. short-term memory loss and hemiparesis, eac i j tjon f,jph magnification, and excellent illumination. .ONCLUSION: Rigid endoscopy affords good op ' patients and can be achieved using the rigid Total or near total resection of colloid c y s t s s h o u l d e t h ^ g " ^ - ^ P o( ^ ^ reso,ut|on fflf symptoms endoscope, with little morbidity, shortened operative’ ' hould be conside,ed as a primary treatment Although long-term follow-up is neededw e th.nk that PY for most patients. (Neurosurgery 44.1 Key words: Colloid cyst, Endoscopy, Hydrocephalus, Third ve C olloid cysts are benign tumors that usually , the roof of the third ventricle. In most pa 1 ' ^ cysts present as small lesions located at t e o .^ird Monro, but they can also be observed throug ou ventricle or they may involve the septum pe uci £ nices a 9,11,25). Although the most worri^me^sy ^ acute obstructive hydrocephalus and possi occur, this type of presentation is exceedingly • 'ore commonly, patients present with comp am -t Tie, nausea, vomiting, memory loss, altere Per^ , mag- isturbance, or visual obscuration. The intro uc * numbers e«c resonance imaging (MRI) has led to increasig f symptomatic cysts being identified mci en a >bservation treatment considerations include conserva man- vith serial radiographic studies, ventricular shun g the hydrocephalus, and direct obliteration guJ.gicai 1 wditionally, colloid cysts have been treated by resection, using either the transcallosal or transfrontal ap- proach (1, 34). In most patients, these procedures can be performed safely, although there is an inherent morbidity associated with any craniotomy. Minimally invasive tech- niques have been developed to reduce the complications as- sociated with craniotomy. Stereotactic aspiration is one alter- native but has the disadvantage of being a blind procedure that is associated with a high rate of recurrence (4, 6,18,19, 23, 26-30, 33). During recent years, endoscopic techniques have been refined and have increasingly been used to treat an assortment of pathological processes inside and outside of the ventricles, including colloid cysts (5, 7, 8, 12-17, 20, 21, 24, 27, 32). The technique has the advantage of direct tumor visual- ization, while being minimally invasive, and has been associ- ated with little morbidity and good results. This report de- scribes our recent experience using the rigid endoscope to treat colloid cysts. ...raery. V o l. 44 No. 5, May 1 9 9 9 1103