Microsurgical resection or
ventriculoperitoneal shunt placement was for a long time the only means of treatment for patients with
colloid cysts. In the past few years, however, endoscopic procedures have gained increasing significance and have been used more widely. Long-term results are now available for the first time, which enabled us to evaluate this method and assess its future relevance.
METHODS: Twenty patients with symptomatic
colloid cysts of the third ventricle have been treated endoscopically in our department during the past 10 years. Retrospective analysis and follow-up of the patients' clinical and radiological outcomes were performed.
RESULTS: In the early postoperative period, 18 patients had excellent outcomes, with clinical signs improving immediately. One patient experienced intraoperative
hemorrhage followed by temporary postoperative
psychosis and IIIrd
cranial nerve palsy. Another patient remained shunt-dependent because of
aseptic meningitis after the endoscopic procedure. In the long-term follow-up, one patient had to be reoperated to treat
cyst recurrence. The
operative time was strongly dependent on the
cyst material as well as on the surgeon's experience with endoscopic techniques; it varied between 60 and 300 minutes (mean
operative time, 200 min). The average hospitalization time was 9 days. Long-term follow-up ranging from 1 to 10 years showed a clear benefit in each patient. In three individuals with pre- and postoperative short-term memory deficits and in one patient who complained of
headaches, symptoms resolved gradually during the first few months after surgery. The patient with intraoperative
hemorrhage complained of slight permanent short-time
memory deficit. The analysis of postoperative computed tomographic and magnetic resonance imaging scans revealed a remaining
cyst wall in the majority of patients and an inconsistent decrease in ventricular size. Postoperative cine magnetic resonance imaging studies showed normalization of cerebrospinal fluid flow in 17 patients.
CONCLUSION: Continued improvement of endoscopic techniques and instruments, together with good long-term results in endoscopically treated patients, have established this method as an alternative to microsurgical techniques and might even set a new standard for treatment.