Transseptal interforniceal endoscopic removal of superiorly recessed colloid cysts Journal Article
| Authors: | Tosi, U.; Uribe-Cardenas, R.; Lara-Reyna, J.; Villamater, F. N.; Perera, I.; Stieg, P. E.; Tsiouris, A. J.; Souweidane, M. M. |
| Article Title: | Transseptal interforniceal endoscopic removal of superiorly recessed colloid cysts |
| Abstract: | OBJECTIVE Transforaminal endoscopic colloid cyst resection is well described. However, some anatomical colloid cyst variants may warrant a modified approach. Rarely, colloid cysts separate the forniceal columns and grow superiorly within the leaflets of the septum pellucidum. Thus, the authors’ goal was to characterize the imaging features, clinical presentation, surgical strategy, and outcomes of patients with this superiorly recessed colloid cyst variant. METHODS A retrospective evaluation of patients who underwent endoscopic resection of colloid cysts from 1999 to 2020 was performed. The patients were dichotomized depending on whether the cyst was located predominately below the forniceal columns or was superiorly recessed (forniceal column separation with variable intraseptal extension). This comparative cohort study focused on clinical presentation, imaging features, operative technique, and patient outcome. RESULTS In total, 182 patients were identified. Seventeen patients had colloid cysts that were defined as superiorly recessed and underwent transseptal interforniceal removal, and 165 patients underwent a standard transforaminal approach. Patients had similar demographic characteristics. However, transseptal cysts were on average larger (17.8 mm vs 11.4 mm, p < 0.0001), and these patients had a greater frontal-occipital horn ratio (0.45 vs 0.41, p = 0.012). They were also more likely to have undergone a previous resection (p = 0.02). The two cohorts had similar surgical outcomes, with no differences in extent of resection, recurrence, or complications. CONCLUSIONS Superiorly recessed intraseptal colloid cysts are larger and tend to splay the bodies of the fornix, thus requiring a parasagittal transseptal interforniceal endoscopic approach. This achieves complete removal with comparatively negligible morbidity or rare recurrence (5.9%). ©AANS 2022. |
| Keywords: | adult; controlled study; treatment outcome; treatment response; middle aged; surgical technique; major clinical study; clinical feature; postoperative period; nuclear magnetic resonance imaging; outcome assessment; recurrence risk; disease association; computer assisted tomography; image analysis; morbidity; cohort analysis; retrospective study; postoperative complication; clinical evaluation; endoscopic surgery; hospital discharge; anxiety; endoscopy; irritability; hydrocephalus; brain third ventricle; demographics; colloid cyst; septum pellucidum; human; male; article; intraseptal; transseptal interforniceal; transseptal interforniceal endoscopic surgery |
| Journal Title: | Journal of Neurosurgery |
| Volume: | 137 |
| Issue: | 3 |
| ISSN: | 0022-3085 |
| Publisher: | American Association of Neurological Surgeons |
| Date Published: | 2022-09-01 |
| Start Page: | 813 |
| End Page: | 819 |
| Language: | English |
| DOI: | 10.3171/2021.11.Jns211754 |
| PUBMED: | 35090131 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
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