Endoscopically Treated Third Ventricle Colloid Cysts: A Systematic Review of Surgical and Clinical Outcomes

TL;DR

This study reviews the outcomes of endoscopic surgery for third ventricle colloid cysts, finding it to be a safe and effective treatment with low complication rates and good long-term results.

Contribution

The paper provides a systematic review of endoscopic resection outcomes for TVCCs, comparing techniques and evaluating recurrence and complication rates.

Findings

Gross total resection was achieved in 68.3% of patients, with higher success in transforaminal and transeptal approaches.

Recurrence occurred in 3.7% of cases, with 2.9% requiring reoperation.

Endoscopic resection was associated with a low mortality rate (0.7%) and manageable complication rates.

Abstract

Background/Objectives: Third ventricle colloid cysts (TVCCs) are benign lesions that may cause acute hydrocephalus and, rarely, sudden death. Endoscopic resection has emerged as a minimally invasive alternative to microsurgical approaches. This systematic review aimed to evaluate the safety and efficacy of endoscopic resection of TVCCs. Methods: Following PRISMA guidelines, a systematic search of major databases was performed to identify studies reporting clinical outcomes of endoscopic resection of TVCCs. Extracted data included the surgical technique, extent of resection, complications, recurrence, and reoperations. Results: Thirty-four studies comprising 1123 patients were included. Gross total resection (GTR) was achieved in 767 patients (68.3%), with higher rates for the transforaminal (88.4%) and transeptal (86.9%) approaches (z = 0.309; p = 0.76). Capsule removal was performed in 87.4% and coagulation alone in 11.6%. Postoperative remnants occurred in 172 patients (17.1%). Recurrence was observed in 41 cases (3.7%) after a mean follow-up of 46.3 months, with 33 patients (2.9%) requiring reoperation. Preoperative hydrocephalus was present in 51% of cases. Septostomy and external ventricular drainage were performed in 15.7% and 15.5% of patients, respectively. Complications included memory deficits (3.6%), meningitis (3.6%), intraventricular hemorrhage (2.7%), ischemia (1.1%), shunt dependency (2.1%), and seizures (0.6%). Mortality occurred in eight patients (0.7%). Conclusions: Endoscopic management of TVCCs is associated with a low complication rate and favorable long-term outcomes. Capsule resection reduces the risk of recurrence and the need for reoperation.

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