Stereotactic-Endoscopic Therapy of Colloid Cysts

Abstract

There exists considerable controversy regarding the optimal therapy of colloid cysts of the foramen of Monro [9, 13]. Whereas some authors propose an aggressive surgical approach as the appropriate and definitive therapy [4, 12], others suggest a less invasive stereotactic approach employing cyst aspiration [1, 10]. The stereotactic approach is undoubtedly associated with significantly lower morbidity and mortality, but it seems that complete aspiration of the cyst content can be achieved only in 50%–80% of cases. In almost 100% of cases open transcallosal or transventricular resection of the cyst results in complete resection of the whole cyst but carries the risk of severe neuropsychological sequelae [6, 7]. Regarding this dilemma we have analyzed our patient material of colloid cysts in terms of the morbidity/mortality of stereotactic cyst aspiration as well as the therapeutic end-point. Concerning the therapeutic results we used a somewhat different approach; in our opinion a good result in this benign disease with rare recurrence is not characterized by complete ablation of the cyst and optimal appearance on computed tomography (CT) or magnetic resonance imaging but by a patient status without neurological symptoms, without obstruction of the CSF pathways, and with a Karnofsky index of 100. Thus we analyzed our data according to both criteria, complete aspiration and functionally excellent results.