gms | German Medical Science

Objective: The aim of this retrospective study was to evaluate the long-term results after endoscopic removal of colloid cysts.

Method: 20 patients underwent endoscopic treatment of colloid cysts in a period of 16 years (1993-2008). Nineteen of these patients (9 female, 10 male) agreed with a follow-up examination. MR images were obtained in 18 patients. The age of the patients ranged from 14 to 61 years (mean age 39.3 years). All patients except one presented with hydrocephalus caused by blockage of CSF circulation at the foramen of Monro. Symptoms included headache, nausea, vomiting, dizziness, neuropsychological deficits, loss of consciousness, paresthesia, hemiparesis, and impaired vision. The goal of surgery was total cyst resection which was achieved in 16 procedures. In 3 patients, small cyst remnants firmly attached to the tela choroidea were left in place to avoid injury of the internal cerebral veins. In the one patient presenting without hydrocephalus, only an inspection and shrinking of the choroid plexus was performed since the cyst was completely covered by the fornices and therefore not easily accessible. In one patient with a large cyst which could not be aspirated, the endoscopic procedure was abandoned and a microsurgical resection was performed.

Results: The average follow-up period was 116.5 month (range 15-220 month). The symptoms resolved completely in 17 patients and improved in 2 patients. The neuropsychological performance seems to improve after resolution of the hydrocephalus, but since we have no preoperative testing we cannot compare the results of tests at the follow-up examination. In the one patient who underwent only an inspection, the symptoms (headache) persisted, but interestingly this cyst has not grown for 13 years. There was no mortality or permanent morbidity. Minor temporary complications such as meningitis-like-symptoms, symptomatic transitory psychotic syndrome, and vertical gaze palsy occurred in 6 cases. One patient died because of problems not related to the cyst. In 15 patients who underwent total resection, no recurrence was observed (1 patient refused MR imaging). In the 3 patients with minor capsule remnants, 1 stable cyst remnant and 1 progressing cyst remnant were observed. But to date, all patients have been without symptoms.

Conclusions: Endoscopic resection is a safe and effective treatment option in colloid cysts providing excellent long-term results. Total cyst removal should be the aim of surgery since capsule remnants may lead to recurrence.