Colloid cyst

Colloid cyst
Histopathology of colloid cyst
Classification and external resources
ICD-10 Q04.6
eMedicine med/2906 radio/96
CT scan of a 1 cm colloid cyst

A colloid cyst is a cyst containing gelatinous material in the brain. It is almost always found just posterior to the foramen of Monro in the anterior aspect of the third ventricle, originating from the roof of the ventricle. Because of its location, it can cause obstructive hydrocephalus and increased intracranial pressure. Colloid cysts represent 0.5%-1% of intracranial tumors.[1]

Symptoms can include headache, vertigo, memory deficits, diplopia, behavioral disturbances and in extreme cases, sudden death. Intermittency of symptoms is characteristic of this lesion.[2] Untreated pressure caused by these cysts can result in brain herniation.[3] Colloid cyst symptoms have been associated with 4 variables: cyst size, cyst imaging characteristics, ventricular size, and patient age. The developmental origin is unclear, though they may be of endodermal origin, which would explain the mucin-producing, ciliated cell type. These cysts can be surgically resected, and opinion is divided about the advisability of this.

Symptoms

Patients with third ventricular colloid cysts become symptomatic when the tumor enlarges rapidly, causing CSF obstruction, ventriculomegaly, and increased intracranial pressure. Some cysts enlarge more gradually, however, allowing the patient to accommodate the enlarging mass without disruption of CSF flow, and the patient remains asymptomatic. In these cases, if the cyst stops growing, the patient can maintain a steady state between CSF production and absorption and may not require neurosurgical intervention.[4]

Diagnosis

Colloid cysts can be diagnosed by symptoms presented. Additional testing will be required and the colloid cyst symptoms can resemble those of other diseases. MRI and CT scans are often used to confirm diagnosis.[5]

Treatment

Various management options exist depending on the severity of symptoms and their effect on the patient. The main management options are: observation, craniotomy for microsurgical resection, neuroendoscopic removal, stereotactic drainage, and cerebrospinal fluid diversion with bilateral ventriculoperitoneal shunting placement.[6]

Surgical resection

Multiple studies have been found on how to remove a colloid cyst. One is an endoscopic removal. To remove the cyst, make a small incision. The endoscope is inserted into the brain and then moved toward the tumor in the ventricular compartment. The tumor is hit with an electric current. The interior of the cyst is removed followed by the cyst wall. The electric current is then used to kill the remaining pieces of the cyst. This whole process, including closing of the incision and removal of the scope is completed within 45 minutes to an hour. The patients are able to leave the hospital after 1 or 2 days.[7] A case was done with the absence of ventriculomegaly that has been contraindication in an endoscopic removal. The study found that with normal-sized ventricles are not a contraindication. They actually have comparable or less complication rates.[8] Another study experimented with a smaller retractor tube, 12 mm instead of 16–22 mm. The study found that using a 12 mm tube on a 10 mm colloid cyst. The surgery was successful in removing the cyst with a smaller retractor tube for resection while minimizing injury. The surgery had potential for improving outcomes.

Neuroendoscopic third ventriculostomy during surgery can be used to prevent further hydrocephalus post op. This removes the need for insertion of bilateral shunts.[6]

References

  1. ↑ Peeters, Sophie M.; Daou, Badih; Jabbour, Pascal; Ladoux, Alexandre; Abi Lahoud, Georges (2016-06-01). "Spontaneous Regression of a Third Ventricle Colloid Cyst". World Neurosurgery. 90: 704.e19–22. ISSN 1878-8769. PMID 26968449. doi:10.1016/j.wneu.2016.02.116.
  2. ↑ Shaktawat, Sameer S; Salman, Walid D; Twaij, Zuhair; Al-Dawoud, Abdul (25 July 2006). "Unexpected death after headache due to a colloid cyst of the third ventricle". World Journal of Surgical Oncology. 4: 47. ISSN 1477-7819. PMC 1550234 Freely accessible. PMID 16867192. doi:10.1186/1477-7819-4-47.
  3. ↑ Schiff, David. "Cysts" (PDF). American Brain Tumor Association. American Brain Tumor Association. Retrieved 26 October 2014.
  4. ↑ Pollock, BE; Schreiner, SA; Huston, J 3rd (May 2000). "A theory on the natural history of colloid cysts of the third ventricle.". Journal of Neurosurgery. 46: 1077–81; discussion 1081–3. PMID 10807239. doi:10.1097/00006123-200005000-00010.
  5. ↑ Turillazzi, Emanuela; Bello, Stefania; Neri, Margherita; Riezzo, Irene; Fineschi, Vittorio (2012-01-01). "Colloid cyst of the third ventricle, hypothalamus, and heart: a dangerous link for sudden death". Diagnostic Pathology. 7: 144. ISSN 1746-1596. PMC 3502434 Freely accessible. PMID 23078815. doi:10.1186/1746-1596-7-144.
  6. 1 2 G. Hadjipanayis, Costas; Schuette, Albert J.; Nicholas, Boulis; Charlie, Hao; Daniel L., Barrow; Charlie, Teo (July 2010). "Full Scope of Options". Journal of Neurosurgery. 67 (1): 197–205. PMC 2888508 Freely accessible. PMID 20559107. doi:10.1227/01.neu.0000370602.15820.e4.
  7. ↑ Colloid Cyst – New York Presbyterian Hospital. Nyp.org. Retrieved on 2013-08-15.
  8. ↑ Wait, S. D.; Gazzeri, R.; Wilson, D. A.; Abla, A. A.; Nakaji, P.; Teo, C. (2013). "Endoscopic Colloid Cyst Resection in the Absence of Ventriculomegaly". Neurosurgery. 73 (1 Suppl Operative): 1. PMID 23334281. doi:10.1227/NEU.0b013e3182870980.

Further reading

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