Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade.

OBJECTIVE: Microsurgical resection or ventriculoperitoneal shunt placement was for a long time the only means of treatment for patients with colloid cysts. In the past few years, however, endoscopic procedures have gained increasing significance and have been used more widely. Long-term results are now available for the first time, which enabled us to evaluate this method and assess its future relevance. METHODS: Twenty patients with symptomatic colloid cysts of the third ventricle have been treated endoscopically in our department during the past 10 years. Retrospective analysis and follow-up of the patients' clinical and radiological outcomes were performed. RESULTS: In the early postoperative period, 18 patients had excellent outcomes, with clinical signs improving immediately. One patient experienced intraoperative hemorrhage followed by temporary postoperative psychosis and IIIrd cranial nerve palsy. Another patient remained shunt-dependent because of aseptic meningitis after the endoscopic procedure. In the long-term follow-up, one patient had to be reoperated to treat cyst recurrence. The operative time was strongly dependent on the cyst material as well as on the surgeon's experience with endoscopic techniques; it varied between 60 and 300 minutes (mean operative time, 200 min). The average hospitalization time was 9 days. Long-term follow-up ranging from 1 to 10 years showed a clear benefit in each patient. In three individuals with pre- and postoperative short-term memory deficits and in one patient who complained of headaches, symptoms resolved gradually during the first few months after surgery. The patient with intraoperative hemorrhage complained of slight permanent short-time memory deficit. The analysis of postoperative computed tomographic and magnetic resonance imaging scans revealed a remaining cyst wall in the majority of patients and an inconsistent decrease in ventricular size. Postoperative cine magnetic resonance imaging studies showed normalization of cerebrospinal fluid flow in 17 patients. CONCLUSION: Continued improvement of endoscopic techniques and instruments, together with good long-term results in endoscopically treated patients, have established this method as an alternative to microsurgical techniques and might even set a new standard for treatment.

Multislice spiral computed tomography for pediatric intracranial vascular pathophysiologies.

OBJECT: Spiral computed tomography (SCT) and, more recently, multislice SCT (MSCT) angiography have established roles in studying subarachnoid hemorrhage (SAH). Potential advantages in MSCT angiography include rapid acquisition, ready availability, ease of monitoring, high spatial resolution, some temporal resolution, and relative freedom from artifacts. The authors assert that these attributes make MSCT angiography the initial imaging method of choice in the assessment of not just SAH but all intracranial vascular pathophysiologies, particularly in children. METHODS: The installation of a MSCT unit sparked the authors' interest in using MSCT angiography and MSCT venography in cases in which they would have formerly performed magnetic resonance (MR) angiography, MR venography, or catheter angiography as an initial investigational method. They retrospectively evaluated seven cases in which they had used the former imaging techniques to study intracranial vascular pathophysiologies. All scans were obtained on a Siemens Sensation 16-slice scanner, and postprocessing was performed on a Leonardo Workstation. RESULTS: Multislice spiral CT consistently provided useful vascular imaging of a wide variety of intracranial vascular pathophysiologies and an alternative imaging modality in patients considered to be too unstable for more time-consuming investigations. CONCLUSIONS: Multislice spiral CT offers advantages over MR imaging in the assessment of intracranial vascular pathophysiologies and frequently allows complete avoidance or deferral of catheter angiography.

Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade.

OBJECTIVE: Microsurgical resection or ventriculoperitoneal shunt placement was for a long time the only means of treatment for patients with colloid cysts. In the past few years, however, endoscopic procedures have gained increasing significance and have been used more widely. Long-term results are now available for the first time, which enabled us to evaluate this method and assess its future relevance. METHODS: Twenty patients with symptomatic colloid cysts of the third ventricle have been treated endoscopically in our department during the past 10 years. Retrospective analysis and follow-up of the patients' clinical and radiological outcomes were performed. RESULTS: In the early postoperative period, 18 patients had excellent outcomes, with clinical signs improving immediately. One patient experienced intraoperative hemorrhage followed by temporary postoperative psychosis and IIIrd cranial nerve palsy. Another patient remained shunt-dependent because of aseptic meningitis after the endoscopic procedure. In the long-term follow-up, one patient had to be reoperated to treat cyst recurrence. The operative time was strongly dependent on the cyst material as well as on the surgeon's experience with endoscopic techniques; it varied between 60 and 300 minutes (mean operative time, 200 min). The average hospitalization time was 9 days. Long-term follow-up ranging from 1 to 10 years showed a clear benefit in each patient. In three individuals with pre- and postoperative short-term memory deficits and in one patient who complained of headaches, symptoms resolved gradually during the first few months after surgery. The patient with intraoperative hemorrhage complained of slight permanent short-time memory deficit. The analysis of postoperative computed tomographic and magnetic resonance imaging scans revealed a remaining cyst wall in the majority of patients and an inconsistent decrease in ventricular size. Postoperative cine magnetic resonance imaging studies showed normalization of cerebrospinal fluid flow in 17 patients. CONCLUSION: Continued improvement of endoscopic techniques and instruments, together with good long-term results in endoscopically treated patients, have established this method as an alternative to microsurgical techniques and might even set a new standard for treatment.