Colloid cyst

colloid cyst presentation

1. CASE PRESENTATION DR USMAN HAQQANI RESIDENT NEUROSURGERY B LADY READING HOSPITAL PESHAWAR

2. Case presentation History 47 years old gentleman had intermittent headache and impaired recent memory from 3 months and gradually his symptoms accelerated .

3. Clinical examination revealed no focal neurological signs but loss of recent memory was present. Eye examination

4. CT was Advised

5. Still in doubt ?

6. Diagnosis ?

7. Operative technique

8. Post op MRI

9. The patient discharged with good neurological condition 0n 6 th postoperative day. At the 3 rd month of follow up, the patient did not show any focal neurological deficite and memory disorder was remitted . ********

10. Colloid cysts. Colloid cysts are benign, congenital epithelium-lined cysts that almost always arise in the anterior third ventricle . Colloid cysts of the third ventricle are located at the level of the foramin of monro . Attached to the roof or floor, fornix, or the choroid plexus. Size range from few mm to several cm. Small ones may be asymptomatic. Histology consists of pseudo stratified columnar or cuboidal epithelium.

11. Epidemiology 0.5-1 % of intracranial tumors. 15 to 20% of Intraventricular mass Female= Male Incidence: General population: 3/100,0000/year Age: Common in adults Range: 20-30 years.

12. History Colloid cyst IST REPORTED. By Wallman in 1858 IST OPERATED. By Dandy in 1921. In 1983, Pawer et al reported the first successful endoscopic aspiration of a third ventricle colloid cyst

13. Clinical features. P resentation in childhood is rare. The tumors are usually symptomatic in patients aged 20-50 years C ommon Symptoms include: Intr acranial hypertension . paroxysmal headache progressive headache Drop attacks severe cases, coma or even death can occur.

14. Clinical presentation cont; Impaired memory. Visual impairment. Papilloedema. Gait abnormalities. Sudden LOC. Sudden death. Asymptomatic seizures

15. Diagnostic imaging Computed tomography. Magnetic resonance imaging.

16. CT BRAIN On CT colloid cyst appear as rounded or oval lesion in the anterior and superior areas of 3 rd ventricle at the level of foramina of Monro . Hypo or hyperdence to brain with minimal to no enhancement in its wall

17. MRI & MRA MRI: Three dimensional, multiplanar. Exact tophography. Preoperative surgical planning. Differentiates cysts from tumors. Hyperintense on T1WI Hyperintense on T2WI. MRA : Replaced the DSA .

18. Diffrential diagnosis Intra ventricular meningeoma Neurocysticercotic cyst Subependymoma Choroid plexus papilloma

19. Surgical management Transcranial Trans cortical, trans ventricular approach( Frontal lobe) Trans callosal approach. Endoscopic aspiration/ excision Sterotaxic aspiration

20. Patient selection Neurological deterioration occures in a small number of patients but high risk patients may not be identified Therefore , the mere surveillance is justified only in the elderly in those with low life expectancy those with increased anesthetic risk

21. Recommended for Removal Symptomatic patient Ventriculomegaly Progressive size Cyst size >1cm

22. Endoscopic removal is safe and effective for treatment of colloid cyst of third ventricle provides good optical resolution and high magnification, through which total or near total resection can be achieved Decreased hospital stay, more rapid return to active life , low direct surgical morbidity and resolution of symptoms

23. Disadvantage requires experience. Cyst location and degree of distension of the third ventricle roof may cause problems when using a rigid endoscope Traction on adherent ceiling remains of the capsule may lead to bleeding A major bleeding can blur the image and can be difficult to stop using the available specific tools. not always the colloid cyst can be completely removed.

24. Craniotomy Cyst >2cm may compromise and adhere to the fornix and maybe more safely removed using microscopic bimanual disection If imaging predicts consistensy of cyst to be hard and cheesy Transcallosal approach is used especially in the absence of ventriculomegaly .

25. Complications Fornix lesions by the manipulation of instruments thermal damage by excessive coagulation intraoperative bleeding aseptic or septic ventriculitis are potential complications of endoscopic surgery Overall morbidity is transient.

26. THANK YOU