Resident Weill Cornell Medicine New York City, New York, United States
Disclosure(s):
Umberto Tosi, MD: No financial relationships to disclose
Introduction: Endoscopic resection has gained traction over the last two decades for treatment of third ventricular colloid cysts. Increasing experience and the development of new surgical instruments and techniques have allowed this approach to reach clinical prominence. In this study, we review our 25-year experience with 200 endoscopic resections of colloid cysts, assess factors predictive of operative success, and critically analyze our evolving clinical practice.
Methods: A retrospective review of prospectively acquired data was carried out. 200 patients with third ventricular colloid cysts were operated on by the senior author between 1995 and 2021 and included in this analysis. Demographics, imaging features, presenting symptomatology, operative approach, surgical outcomes, and complications were analyzed in 5-year intervals to determine overall outcomes and changing patterns over time. Bivariate analyses were carried out to understand factors predisposing to subtotal resection (STR) or recurrence. Kaplan-Mayer curves were used to analyze time-to-recurrence
Results: Over time, an increase in operated asymptomatic patients was observed (p < 0.001). Rate of recurrence and length of stay all decreased over time (p < 0.001), whereas the rate of gross total resection increased (p < 0.001), indicating continued improvement in our technique. Rate of major complications or need for postoperative CSF diversion remained low. Bivariate analyses indicated how STR is the only factor associated with recurrence.
Conclusion : Our 25-year experience posits endoscopic resection as a safe approach to third ventricular colloid cysts, with low recurrence rates and negligible complications. These results are achieved thanks to continuous improvement of operative tools, endoscopic technique, preoperative planning, and surgical experience.
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