Turkish Neurosurgery
Transcortical Removal of Third Ventricular Colloid Cysts: A comparison of Conventional, Guided Microsurgical and Endoscopic Approaches and a Review of the Literature
Pulat Akin Sabanci1, Yavuz Aras1, Achmet Ali2, Tuğrul Cem Ünal1, Duygu Dölen1, Serra Sencer3, Nail İzgi1, Faruk Ünal1, Orhan Barlas1
1İstanbul School of Medicine, Neurosurgery, İstanbul,
2İstanbul School of Medicine, ANESTHESIOLOGY, İSTANBUL,
3İstanbul School of Medicine, Radiology, İstanbul,
DOI: 10.5137/1019-5149.JTN.17142-16.2
Aim:To compare the clinical results of different transcortical approaches for the removal of third ventricular colloid cysts.Material and Methods:Records of 41 colloid cyst patients who were underwent transcortical conventional microsurgical, microsurgical with the aid of stereotactically guided cylindrical retractor (minitubular) and endoscopic removal between 1999 and 2015 were retrospectively analyzed. The clinical results of these three different transcortical surgical approaches were compared and a literature review of published series was conducted.Results:Ages ranged between 16 and 66 (mean: 36.8). There were 18 females and 23 males. Headache was the main presenting symptom. The mean CC diameter was 15.5 mm. Intraventricular hemorrhage was encountered in 2 patients. 3 patients needed postoperative ventriculoperitoneal shunt surgery. Postoperative seizures were seen in 3, postoperative neurological deficit in 3 and residual tumor in 2 patients. Conventional approach resulted in significantly higher rates of postoperative seizure compared to minitubular and endoscopic approaches (p=0.012). The rate of residual cyst was significantly higher in endoscopic approach compared to conventional and minitubular approaches (p=0.024). Conventional approach led to significantly higher rates of neurological deficit compared to two other approaches (p<0.05).Conclusion:With respect to complication rates, the stereotactic and endoscopic approaches are both safe and reliable compared to conventional microsurgical approach which has unacceptably high rates of seizures and neurological deficit. Concerning completeness of removal both microsurgical approaches are by far superior to neuroendoscopy. Stereotactic microsurgical approach compares favorably in both respects with endoscopic and conventional microsurgical approaches.
Corresponding author : Pulat Akin Sabanci