Introduction: The absence of ventriculomegaly has been considered an overt or relative contraindication to the endoscopic resection of colloid cysts.
Reports of successful endoscopic surgery in small ventricles are surfacing. We examined the combined experience of 2 high-volume endoscopic centers to characterize the outcomes of patients undergoing endoscopic removal of colloid cysts in small ventricles.
Methods: We retrospectively reviewed all endoscopic colloid cyst removal procedures by the 2 senior authors (PN, CT) performed at the Barrow Neurological Institute or the Centre for Minimally Invasive neurosurgery over an 8-year period. Radiographic, clinical, and interview data were recorded and analyzed. The age-adjusted relative bicaudate index was used to define “small ventricles.”
Results: Sixteen patients (8 females) underwent attempted endoscopic removal of a colloid cyst in the absence of ventriculomegaly. Surgery was technically successful in 15 cases. The cyst was removed completely in 13 of cases. Short-term memory loss was initially present in 3 cases and completely resolved in all but 1 patient who had presented with short-term memory loss. Temporary complications occurred in 2 patients.
Conclusions: Normal-sized ventricles are not a contraindication to endoscopic removal of third ventricular colloid cysts. Complication rates are at least comparable to those of patients with ventriculomegaly or to those undergoing open microsurgical resection.
Patient Care: More surgeons will understand that endoscopic surgery in small ventricles is technically feasible, thereby offering more patients a less morbid, equally effective operation in many cases.
Learning Objectives: By the end of the session participants should be able to:
1) describe the technique of endoscopic colloid cyst removal in small ventricles.
2) Describe relative indications for surgery
3) Be able to adequately counsel patients about the risks and benefits of endoscopic removal of colloid cysts in small ventricles