Article
Colloid cyst of the third ventricle – a rare case of spontaneous regression
Kolloidzyste des dritten Ventrikels – Fallbericht einer spontanen Rückbildung
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Authors
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Martin E. Weidemeier
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Joerg Baldauf
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: A case report of spontaneous regression of a colloid cyst is presented. Additionally, a review on the present literature is discussed.
Methods: We report about a 48-year-old man who initially presented with a 12-month-history of daily intermitting headache and quotidian self-limiting visual blurriness in the morning. A MR imaging showed a cystic, sharp-edged lesion close to the left foramen of Monro which appeared isointense on T1-weighted images, slightly hyperintense on T2-weighted images and no gadolinium enhancement thus being highly suggestive for a colloid cyst. Since there was no sign of cerebrospinal fluid (CSF) flow obstruction, serial neuroimaging as follow-up was performed. Over the course of three years with ongoing symptoms of recurring headaches and visual impairment follow-up MR imaging demonstrated no changes in the cyst configuration. However, after four years the regular follow-up MRI demonstrated the disappearance of the cyst without the patient having undergone any treatment in the meantime. The headaches kept their intermittent pattern, the patient did not describe any other alteration or acute temporary deterioration of symptoms.
Results: Our case is an extraordinary rare example of a spontaneous resolution of a colloid cyst. Colloid cysts are commonly located in the third ventricle close to the foramen of Monro. Due to growth they may obstruct the foramen and thus the circulation of CSF consecutively causing an obstructive hydrocephalus. However, not all cysts demand for neurosurgical resection since both size and location might not interfere with CSF flow. In rare cases, even a spontaneous regression seems possible and is reported in four cases worldwide to date. The actual reason for cyst resolution remains unclear.
Conclusion: This is the fifth case since 2002 reported about a spontaneous regression of a colloid cyst. The underlying mechanism is thought to be of a spontaneous release of the cyst content by rupture possibly leaving remnants like a cystic wall behind. Being a benign lesion, colloid cysts may be found incidentally but may also present with neurological symptoms and sudden death. In asymptomatic patients follow-up with serial neuroimaging is sufficient as only few cases will demand neurosurgical intervention later on. The presented case is rare but has to be kept in mind when surgical indication is discussed for colloid cysts.
