Colloid cysts: Neuropsychological outcome, quality of life and long-term control after endoscopic gross total resection.

BACKGROUND: Endoscopy is increasingly being adopted for removing colloid cysts. However, the neuropsychological outcome and quality of life (QOL) have not been studied in detail. This study is to evaluate the efficacy of endoscopic excision on cognitive measures and QOL. METHODS: Patients with colloid cysts larger than 7 mm, undergoing endoscopy were prospectively studied concerning clinico-radiology, cognitive parameters (age and education adjusted), extent of resection and recurrence. A cross-sectional QOL assessment was additionally performed on endoscopic patients in comparison with cases who underwent microsurgery or standalone ventriculo-peritoneal (VP) shunt. RESULTS: A total of 22 endoscopic patients with a mean age of 34 years and a mean cyst diameter of 19 mm were studied. Gross total resection(GTR) could be achieved in all. Over a mean follow-up of 53.4 months, none had a recurrence, ventriculomegaly, or retreatment. Among neuropsychological parameters, digit span was the most affected before surgery. There was a broad-based improvement in the mean global cognitive score from 40.63(±10.4) at baseline to 50.25(±5.8) after endoscopy with maximum improvement in 'immediate recall.' The change in scores also had a significant inverse correlation with cyst size, with cysts larger than 18 mm, resulting in lower scores following endoscopy(R=-0.9, P=0.01). QOL was significantly influenced by visual and cognitive impairments and was better among endoscopic patients than similar microsurgery or VP shunt controls, with a significant difference in social and environmental domains(P=0.02). CONCLUSION: Endoscopy is effective in achieving GTR and long-term control, with neuropsychological improvement correlated with cyst size. This is probably the first report to show QOL is influenced by cognitive parameters and is better following endoscopy than after microsurgery or VP shunt.

The Impact of Colloid Cyst Treatment on Neurocognition.

BACKGROUND: Colloid cysts (CC) have been associated with neurocognitive function (NCF) decline, both preoperatively and after resection. Factors such as local pressure on the fornix and hydrocephalus are thought to contribute to preoperative NCF decline. The potential cause of postoperative decline is thought to be forniceal injury during surgery. In the current series, we describe NCF outcomes amongst patients with CC, both nonoperated and operated. METHODS: A total of 36 patients (23 operated, 13 nonoperated) were included in this retrospective study. All patients underwent at least 1 NCF evaluation battery. Of the 13 nonoperated cases, 5 had follow-up tests too. Of the 23 operated, 14 had both pre- and postoperative tests, and 8 had early and late postoperative tests. RESULTS: There was no significant difference in baseline NCF between nonoperated and operated cases (as evaluated preoperatively). Nonoperated patients had a stable NCF test over time. Patients who were operated showed a significant improvement after surgery in several NCF variables. There was no significant change in NCF between early and late postoperative evaluation. None of the operated patients had a postoperative NCF decline. CONCLUSIONS: Patients with CC should undergo routine NCF testing with a standardized protocol, whether they are operated or followed. Surgery has a positive impact on NCF; however, it remains to be determined if the improvement is solely secondary to treatment of hydrocephalus, or to a reduction of local pressure on the fornices. It remains to be determined whether the surgical technique, that is, endoscopic, interhemispheric, or transcortical, has an impact on NCF outcome.

[A clinical and neuropsychological study of patients before and after resection of third ventricle colloid cysts]. / Kliniko-neĭropsikhologicheskie issledovaniia bol'nykh do i posle udaleniia kolloidnykh kist tret'ego zheludochka.

The literature lacks studies of cognitive impairments in large groups of patients after resection of third ventricle colloid cysts. AIM: To evaluate cognitive impairments in patients before and after resection of third ventricle colloid cysts. MATERIAL AND METHODS: We performed a clinical and neuropsychological study of 52 patients with third ventricle colloid cysts using the Luria method (1962). Forty three patients were examined before and after cyst resection in the early postoperative period (three patients in this group were also examined in a long-term period of 3-7 months after surgery). Forty one patients were operated on using the transcallosal approach, and two patients were operated on using the subtentorial-supracerebellar transchoroidal approach. The other patients were examined only before or after surgery. The patients' age ranged from 14 to 61 years; the mean age was 33.8 years; the median age was 29 years. RESULTS: On examination before surgery, cognitive impairments were minimal in 5 patients without clear signs of hydrocephalus. Impairments of memory and dynamic praxis, mild spatial disorders, and psychological inertia were observed in other patients with hydrocephalus. There was no significant difference in the state of cognitive functions between patients with and without stagnation in the fundus. On examination on day 3-6 after transcallosal surgery, several groups of patients were identified. Eight patients had an improvement in cognitive functions, which might be related to postoperative resolution of hydrocephalus. In 15 patients, changes in mnestic functions were insignificant. This group consisted of the youngest patients with a median age of 24 years. Korsakoff syndrome and disorientation were detected in 5 patients. This was the oldest age group, with a median age of 48 years. In other 13 patients, aggravation of mnestic disorders was moderate. Similar memory impairments were detected in the case of the subtentorial-supracerebellar approach. Memory disorders progressively regressed in all patients. CONCLUSION: Postoperative memory impairment of a varying degree was found in 21 out of 43 patients, with adhesions between the cyst capsule and fornix being observed only in 5 patients. In this case, no injury to the fornix was intraoperatively observed. We discuss the role of the age factor, cyst size, and technical surgical difficulties in the pathogenesis of memory disorders in the absence of injury to the calvarium during colloid cyst resection.

Quiste coloide hemorrágico del tercer ventrículo: deterioro fulminante / Hemorrhagic colloid cyst of the third ventricle: fulminant deterioration

Introducción. Los quistes coloides son tumores benignos del tercer ventrículo. La mayoría permanecen asintomáticos. Sin embargo, algunos pacientes pueden desarrollar desde cefaleas intermitentes hasta un deterioro agudo e incluso muerte súbita. Existen varias teorías por las que se produciría una muerte súbita en estos pacientes, entre las que se incluyen el rápido crecimiento del quiste, su rotura, la alteración del control cardiovascular reflejo mediado por el hipotálamo y, rara vez, el sangrado del quiste, con sólo 15 casos descritos en la bibliografía. Caso clínico. Varón de 45 años, con hipertensión arterial como único antecedente de interés, que sufre un deterioro brusco del nivel de consciencia a causa de una hidrocefalia aguda debida a un quiste coloide hemorrágico del tercer ventrículo. Se implantó un drenaje ventricular externo en cada lado e ingresó en la unidad de cuidados intensivos, donde se certificó la muerte encefálica. Tras la extirpación del quiste mediante abordaje transcortical frontal, se confirmó el diagnóstico de quiste coloide con restos de material hemolizado subagudo. Conclusión. La hemorragia en los quistes coloides es excepcional y puede producirse en pacientes tanto sintomáticos como asintomáticos, lo que dificulta, de forma extraordinaria, el reconocimiento de esta complicación (AU)

Introduction. Colloid cysts are benign tumors of the third ventricle. Most of them remain asymptomatic. However, some patients can develop since intermittent headaches to an acute deterioration and even sudden death. Several theories exist for which there would be a sudden death in these patients, among which include the rapid increase in size of the cyst, its rupture, the disturbance of hypothalamus-mediated cardiovascular reflex control and the unusual bleeding of the cyst, with only 15 cases described in the literature. Case report. A 45 year old male with hypertension with acute hydrocephalus due to a hemorrhagic colloid cyst in the third ventricle. An external ventricular drain on each side was introduced and he was admitted to the ICU, where brain death was certified. After removal of the cyst through transcortical frontal approach, the diagnosis of colloid cyst with remains of hemolyzed blood was confirmed. Conclusion. Bleeding in colloid cysts is exceptional, and can occur in both symptomatic and asymptomatic patients, making it difficult to recognize this complication (AU)

Long-term benefits of the Memory-Link programme in a case of amnesia.

OBJECTIVE: To systematically evaluate the maintenance of clinical gains from a structured memory intervention programme. Efficacy of the programme was initially demonstrated in RR, a woman with moderate-to-severe memory impairment following colloid cyst removal. In the current study (Svoboda and Richards, 2009), we examined RR's day-to-day memory functioning 18 months after completion of the intervention programme. DESIGN: Within-subject A(1)B(1)A(2)B(2)B(3) single-case experimental design. SETTING: Outpatient memory rehabilitation clinic. INTERVENTION: A theory-driven training programme in the use of commercially available smartphones for individuals with moderate-to-severe memory impairment. MAIN MEASURES: A phone call task was used as an objective measure of prospective memory function. Self-report, ecologically valid questionnaires were also completed to further assess generalization of smartphone use to day-to-day memory function. RESULTS: Eighteen months after intervention, RR completed 80% of scheduled calls using the smartphone, a rate significantly higher than at baseline (40%) and comparable to her success rate immediately following intervention (90%) and at the four-month follow-up (90%). Responses to questionnaires indicated that RR felt more confident in her ability to handle memory-demanding situations and was making fewer memory mistakes. This favourable outcome was not found with the use of another smartphone brand for which training was not received. CONCLUSIONS: Results from ecologically valid measures of memory functioning demonstrated robust maintenance of independent commercial smartphone use over an 18-month period, with increases observed in independence, confidence and real-life memory functioning. The findings further suggest poor cross-device generalizability.