Colloid cyst

Histopathology of colloid cyst
CT scan of a 1 cm colloid cyst

A colloid cyst is a non-malignant tumor in the brain. It consists of a gelatinous material contained within a membrane of epithelial tissue. It is almost always found just posterior to the foramen of Monro in the anterior aspect of the third ventricle, originating from the roof of the ventricle. Because of its location, it can cause obstructive hydrocephalus and increased intracranial pressure. Colloid cysts represent 0.5–1.0% of intracranial tumors.[1]

Symptoms can include headache, vertigo, memory deficits, diplopia, behavioral disturbances, and in extreme cases, sudden death. Intermittency of symptoms is characteristic of this lesion.[2] Untreated pressure caused by these cysts can result in brain herniation.[3] Colloid cyst symptoms have been associated with four variables: cyst size, cyst imaging characteristics, ventricular size, and patient age. Their developmental origin is unclear, though they may be of endodermal origin, which would explain the mucin-producing, ciliated cell type. These cysts can be surgically resected, and opinion is divided about the advisability of this.

## Contents

* 1 Symptoms
* 2 Diagnosis
* 3 Treatment
* 3.1 Surgical resection
* 4 References
* 5 Further reading
* 6 External links

## Symptoms

Patients with third-ventricular colloid cysts become symptomatic when the tumor enlarges rapidly, causing cerebrospinal fluid (CSF) obstruction, ventriculomegaly, and increased intracranial pressure. Some cysts enlarge more gradually, however, allowing the patient to accommodate the enlarging mass without disruption of CSF flow, and the patient remains asymptomatic. In these cases, if the cyst stops growing, the patient can maintain a steady state between CSF production and absorption and may not require neurosurgical intervention.[4]

## Diagnosis

This is an image of a regular brain and a brain with a colloid cyst.

Colloid cysts can be diagnosed by symptoms presented. Additional testing is required and the colloid cyst symptoms can resemble those of other diseases. MRI and CT scans are often used to confirm diagnosis.[5]

## Treatment

There are various management options depending on the severity of symptoms and their effects on the patient. The main management options are observation, craniotomy for microsurgical resection, neuroendoscopic removal, stereotactic drainage, and CSF diversion with bilateral ventriculoperitoneal shunting placement.[6][7]

### Surgical resection

Multiple studies have discussed how to remove a colloid cyst. One option is an endoscopic removal. An endoscope is inserted into the brain via a small incision and then moved toward the tumor in the ventricular compartment. The tumor is hit with an electric current. The interior of the cyst is removed followed by the cyst wall. The electric current is then used to kill the remaining pieces of the cyst. This whole process, including closing of the incision and removal of the scope, is completed within 45 minutes to an hour. The patients are able to leave the hospital after 1 or 2 days.[8] Quality of life is found to be better following endoscopic excision than microsurgery, with cysts smaller than 18 mm showing better cognitive outcome.[9] Another study found that ventriculomegaly may not be a contraindication for endoscopic removal, as the condition has comparable complication rates.[10] Another study experimented with a smaller retractor tube, 12 mm instead of 16–22 mm. The surgery was successful in removing the cyst; the smaller retractor tube minimized resection injury.

Neuroendoscopic third ventriculostomy during surgery can be used to prevent further postoperative hydrocephalus. This removes the need for insertion of bilateral shunts.[6][7]

Patients who have had a colloid cyst removed from the third ventricle sometimes experience some difficulty with day‐to‐day memory. Mammillary body atrophy in patients with surgical removal of colloid cysts indicates that this atrophy is partly due to a loss of temporal lobe projections in the fornix.[11]

## References

1. ↑ Peeters, Sophie M.; Daou, Badih; Jabbour, Pascal; Ladoux, Alexandre; Abi Lahoud, Georges (2016-06-01). "Spontaneous Regression of a Third Ventricle Colloid Cyst". World Neurosurgery 90: 704.e19–22. doi:10.1016/j.wneu.2016.02.116. ISSN 1878-8769. PMID 26968449.
2. ↑ Shaktawat, Sameer S; Salman, Walid D; Twaij, Zuhair; Al-Dawoud, Abdul (25 July 2006). "Unexpected death after headache due to a colloid cyst of the third ventricle". World Journal of Surgical Oncology 4: 47. doi:10.1186/1477-7819-4-47. ISSN 1477-7819. PMID 16867192.
3. ↑ Schiff, David. "Cysts". http://www.abta.org/secure/resource-one-sheets/cysts.pdf.
4. ↑ Pollock, Bruce E.; Schreiner, Shawn A.; Huston, John III (May 2000). "A Theory on the Natural History of Colloid Cysts of the Third Ventricle". Neurosurgery 46 (5): 1077–83; discussion 1081–3. doi:10.1097/00006123-200005000-00010. PMID 10807239.
5. ↑ Turillazzi, Emanuela; Bello, Stefania; Neri, Margherita; Riezzo, Irene; Fineschi, Vittorio (2012-01-01). "Colloid cyst of the third ventricle, hypothalamus, and heart: a dangerous link for sudden death". Diagnostic Pathology 7: 144. doi:10.1186/1746-1596-7-144. ISSN 1746-1596. PMID 23078815.
6. ↑ 6.0 6.1 Hadjipanayis, Costas G.; Schuette, Albert J.; Nicholas, Boulis; Charlie, Hao; Daniel L., Barrow; Charlie, Teo (July 2010). "Full Scope of Options". Neurosurgery 67 (1): 197–205. doi:10.1227/01.neu.0000370602.15820.e4. PMID 20559107.
7. ↑ 7.0 7.1 Garegnani, Luis; Franco, Juan VA; Ciapponi, Agustín; Garrote, Virginia; Vietto, Valeria; Portillo Medina, Santiago Adalberto (2020-06-16). "Ventriculo-peritoneal shunting devices for hydrocephalus". Cochrane Database of Systematic Reviews 2020 (6): CD012726. doi:10.1002/14651858.cd012726.pub2. ISSN 1465-1858. PMID 32542676. PMC 7388891. https://doi.org/10.1002/14651858.CD012726.pub2.
8. ↑ Colloid Cyst – New York Presbyterian Hospital . Nyp.org. Retrieved on 2013-08-15.
9. ↑ Dhandapani, S (1 Oct 2021). "Colloid cysts: Neuropsychological outcome, quality of life and long-term control after endoscopic gross total resection". Clin Neurol Neurosurg 209: 106951. doi:10.1016/j.clineuro.2021.106951. PMID 34547641.
10. ↑ Wait, S. D.; Gazzeri, R.; Wilson, D. A.; Abla, A. A.; Nakaji, P.; Teo, C. (2013). "Endoscopic Colloid Cyst Resection in the Absence of Ventriculomegaly". Operative Neurosurgery 73 (1 Suppl Operative): ons39–ons47. doi:10.1227/NEU.0b013e3182870980. PMID 23334281.
11. ↑ Denby, C. E.; Vann, S. D.; Tsivilis, D.; Aggleton, J. P.; Montaldi, D.; Roberts, N.; Mayes, A. R. (2009-04-01). "The Frequency and Extent of Mammillary Body Atrophy Associated with Surgical Removal of a Colloid Cyst" (in en). American Journal of Neuroradiology 30 (4): 736–743. doi:10.3174/ajnr.A1424. ISSN 0195-6108. PMID 19164441. PMC 7051749. http://www.ajnr.org/content/30/4/736.

## Further reading

* Hamlat, A.; Casallo-Quiliano, C.; Saikali, S.; Adn, M.; Brassier, G. (2004). "Huge colloid cyst: Case report and review of unusual forms". Acta Neurochirurgica 146 (4): 397–401; discussion 401. doi:10.1007/s00701-004-0221-8. PMID 15057535.
* Beems, Tjemme; Menovsky, Tomas; Lammens, M. (2006). "Hemorrhagic colloid cyst". Surgical Neurology 65 (1): 84–6. doi:10.1016/j.surneu.2005.03.034. PMID 16378869.
* Spears, Roderick C. (2004). "Colloid cyst headache". Current Pain and Headache Reports 8 (4): 297–300. doi:10.1007/s11916-004-0011-2. PMID 15228889.
* Benoiton L.A.; Correia J.; Kamat A.S.; Wickremesekera A. (2014). "Familial colloid cyst". Journal of Clinical Neuroscience 21 (3): 533–535. doi:10.1016/j.jocn.2013.08.012. PMID 24308955.
* Melbourne Neurosurgery

## External links

Classification|

* ICD-10: Q04.6

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External resources|

* eMedicine: med/2906 radio/96

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