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Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study

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Abstract

Different management options are available for the treatment of colloid cysts. Goals of those procedures are to achieve a complete resection avoiding potential long-term recurrence along with CSF pathways restoration with minimal morbidity and mortality. The two main surgical options are endoscopic resection or direct removal by either transfrontal or transcallosal approach. The efficacy of endoscopic technique to achieve gross total colloid cyst excision has been well documented. In the present study, authors describe a series of 29 patients who underwent surgery by a variation of the standard worldwide implemented endoscopic technique. Using a more anterior approach, it is easier to reach the roof of the cyst, its possible adherences with the tela choroidea, plexus, and the internal cerebral veins. The described approach has shown to be safe, quick, and very effective with a total cyst removal rate of 86.2 %.

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Authors and Affiliations

  1. Department of Neurosurgery, Strasbourg University Hospital, 1, Av Moliere, 67100, Strasbourg, France

    S. Chibbaro, L. Tigan, D. Chaussemy & P. Kehrli

  2. Department of Neurosurgery, Parma University Hospital, Parma, Italy

    S. Chibbaro, C. Iaccarino, F. Servadei & A. Romano

  3. Department of Neurosurgery, Lariboisière University Hospital, Paris, France

    S. Chibbaro, P. Poczos, M. Cardarelli, B. George & S. Froelich

  4. Department of Neurosurgery, Necker University Hospital, Paris, France

    F. Di Rocco

  5. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK

    C. Champeaux

Authors
  1. S. Chibbaro
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  2. C. Champeaux
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  3. P. Poczos
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  4. M. Cardarelli
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  5. F. Di Rocco
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  6. C. Iaccarino
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  7. F. Servadei
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  8. L. Tigan
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  9. D. Chaussemy
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  10. B. George
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  11. S. Froelich
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  13. A. Romano
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Corresponding author

Correspondence to S. Chibbaro.

Additional information

Comments

Shlomi Constantini and Jonathan Roth, Tel Aviv, Israel

Removing a colloid cyst via a fiber optic conduit is an advanced procedure. While ETV may be considered a mainstream operation that should be part of a standard residency program, advanced endoscopy is an evolving profession that requires subspecialization, having the optimal technology, and accumulated experience.

Chibbaro et al. should be complimented for describing a technical nuance that they feel is important for a better visualization of the delicate place where colloid cysts are attached to important neural and vascular structures. The frontal or even forehead trajectory has been described before for this procedure and is quite widely used; however, providing a clinical series with actual results is important enough to be published. The authors should also be applauded for combining forces of several esteemed centers to reach larger and more meaningful numbers in a clinical series.

Our endoscopic tools are still not sufficient. Working via one channel is limiting, tiring, and may sometimes be challenging especially when venous bleed occurs. The biggest advantage of endoscopy is in providing visual angles that are better (!) then what one sees through the microscope! As such, the trajectory of entrance is crucial in every endoscopic procedure but especially with colloid cysts. This trajectory must be individualized and preferably preplanned on a navigation system.

The true challenge in the decision-making of open versus endoscopic approach for colloid cysts is looking at the cognitive and memory results. With this aspect, I felt the paper of Chibbaro et al. is a bit on the short side! It is time that the neurosurgical community will look carefully and prospectively not only at variables like resectability and major motor deficits!

Siamak Asgari, Duisburg-Essen, Germany

The authors of four neurosurgical institutions present a retrospective study about 29 patients, who underwent transfrontal endoscopic removal of a colloid cyst over a treatment period of 4 years. In 25 patients, a complete cyst removal was achieved. Additionally, in all patients a septum pellucidotomy was performed to avoid unilateral hydrocephalus. Pre- and postoperatively, mini-mental state examination was performed in each patient. This paper deals with a high number of operated colloid cyst patients. Therefore, this study is interesting for the reader. Unfortunately, a lot of unanswered questions remain. Has a septum pellucidotomy being performed in any case of colloid cyst resection and why? The postoperative CT scan of case 2 demonstrates a broad tube-like intracerebral defect along the endoscopic trajectory. Such cortical postoperative damages can lead to epileptic seizures. In cases of preoperative small ventricles, still the risk of deviation in neuronavigation is a problem. The authors give no information about this theme and how to overcome these problems. There is no proven evidence that endoscopic removal of colloid cyst leads to better neuropsychological results than colloid cyst excision via anterior transcallosal microsurgery in very experienced hands. Finally, the content of this paper is in the focus of the neurosurgical reader, especially the modified endoscopic trajectory anteriorly to the coronar entry point is of high interest.

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Chibbaro, S., Champeaux, C., Poczos, P. et al. Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study. Neurosurg Rev 37, 235–241 (2014). https://doi.org/10.1007/s10143-013-0508-4

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  • DOI: https://doi.org/10.1007/s10143-013-0508-4

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