Endoscopic Resection of Colloid Cysts: Use of a Dual-Instrument Technique and an Anterolateral Approach

OBJECTIVE: Endoscopic approaches are increasingly utilized to treat third ventricular colloid cysts but have been associated with lower rates of complete cyst wall resection. Our objective was to assess the results of colloid cyst resection via an anterolateral endoscopic approach with a dual- instrument technique, with an emphasis on completeness of cyst wall resection. METHODS: A retrospective review of the senior author's experience with 22 colloid cysts treated with endoscopic resection since 2004 was performed. Initial cyst size, completeness of resection, postoperative radiographic residual, recurrence at follow-up, need for reoperation, and neurologic morbidity were assessed. All cysts were approached from an anterolateral trajectory with two instruments working in concert through a single endoscope. RESULTS: Of 22 patients, near-total resection was obtained in 95%. In 3 cases, a very small, radiographically occult residual was left. Complete cyst wall resection was therefore obtained in 18 (82%). There were no cases of recurrence at follow-up in any patient. No patients required craniotomy or underwent re-resection. Fifteen of 16 (94%) patients with long-term clinical follow-up remained stable or improved. CONCLUSION: High rates of complete colloid cyst resection, with low morbidity, are possible with an anterolateral endoscopic approach with dual-instrument technique. These results support the findings of other endoscopists that show how technical modifications to traditional endoscopic approaches can produce favorable results.