Treatment of colloid cysts of the third ventricle through neuroendoscopic Nd:YAG laser stereotaxis

Abstract

Objective: Colloid cysts (IIIVT CC) are benign neuroepithelial cysts located in the anterior third ventricle. The authors propose the use of Nd:YAG laser stereotactic neuroendoscopic for guided resection of the third ventricle colloid cysts. Method: Eleven patients presented third ventricle colloid cysts and were treated by Nd:YAG laser guided with stereotactic endoscopy (n=7) , stereotactic endoscopy (n=3) or stereotactly guided puncture (n=1). The patients were followed prospectively (average 33 months, range 19-64 months). The clinical data, neuroimaging findings, hospitalization stay, outcomes and complications of the method were evaluated. Results: All patients presented headache; six had papilledema, one had gait disturbance and one had third-nerve palsy. Neuroimaging showed hydrocephalus and a IIIVT CC with 14.4-mm mean diameter. After surgery all patients presented clinical and image improvement. Only two patients presented transient morbidities that were easily treated: One had diabetes insipidus that lasted for two days and was treated with a single dose of DDAVP, and another had chemical aseptic meningitis, probably due to the contact of the cyst content with the CSF. This patient was treated with antibiotics and corticosteroids with complete resolution of the problem without sequels. The other patients were discharged from the hospital 48 h after surgery. Conclusion: The stereotactic neuroendoscopy-guided procedure with Nd:YAG laser allowed the complete removal of the third ventricle colloid cysts, without definitive morbidities, sequels or recurrence of the lesion.