Rapid Recurrence of a Colloid Cyst after Endoscopic Resection

Case Report

Austin J Surg. 2014;1(7): 1033.

Rapid Recurrence of a Colloid Cyst after Endoscopic Resection

Fontenot P1 and Sandberg DI2*

1Department of Urology, University of Kansas, USA

2Department of Pediatric Surgery, University of Texas Health Science Center at Houston, USA

*Corresponding author: Sandberg DI, Department of Pediatric Surgery, Division of Neurosurgery, University of Texas Health Science Center at Houston, USA, 6431 Fannin Street MSB 5.144, Houston, TX 77005, USA

Received: August 21, 2014; Accepted: September 15, 2014; Published: September 24, 2014


Background: Endoscopic resection of colloid cysts has gained popularity as a less invasive alternative to removal via open craniotomy. Previous publications have emphasized that recurrence rates are low after endoscopic removal of colloid cysts even when the resection is subtotal.

Case Description: We review the case of a 36 year-old man who underwent endoscopic resection of a large colloid cyst. All of the cyst contents and the majority of the cyst wall were removed, with a small remnant of the cyst wall left behind. Postoperative imaging studies immediately after surgery and six weeks later did not definitively demonstrate residual colloid cyst. A subsequent MRI scan nearly seven months post-operatively demonstrated a definitive recurrence of the colloid cyst, which was ultimately removed via an open craniotomy.

Conclusions: This unusually rapid recurrence of a colloid cyst following endoscopic resection has not been well-documented in previously published literature. This case is reported to alert neurosurgeons that close radiographic follow-up is important after endoscopic resection of colloid cysts and to add to the ongoing debate regarding the optimal means of managing these lesions.

Keywords: Colloid cyst; Endoscopic resection; Neuro-endoscopy


Colloid cysts are benign tumors which are located in the anterior portion of the third ventricle [1-4]. They comprise between 0.5 to 2 percent of all intracranial tumors and 15 to 20% of all intraventricular tumors [5,6]. Colloid cysts can be incidental findings on imaging studies or they can present with headaches when they obstruct the foramen of Monro and cause hydrocephalus [1-4]. A rare but feared presentation of colloid cysts is sudden death, presumably from acute obstructive hydrocephalus but possibly related to other mechanisms such as hypothalamic compression [7-9,4]. Visual loss including blindness is also a rare presentation of colloid cysts [10].

Colloid cysts are typically easily identifiable on magnetic resonance imaging (MRI) scans based upon their round symmetry, location in the anterior third ventricle obstructing the foramen of Monro, and gelatinous contents [11]. Small, asymptomatic colloid cysts may be observed with serial imaging studies [12]. When colloid cysts are large, growing, cause obstructive hydrocephalus, or are clearly symptomatic, treatment is warranted. Cerebrospinal fluid (CSF) diversion via shunting is an option, but most neurosurgeons advocate surgical resection of the colloid cyst. Traditionally, surgical resection has been performed by craniotomy, most commonly via an interhemispheric transcallosal approach. With the advent of neuro-endoscopy, endoscopic removal has emerged as an alternative to craniotomy, and considerable debate exists regarding the overall advantages and disadvantages of open versus endoscopic approaches [2,8,13,14].

The main advantages of endoscopic colloid cyst removal include smaller, more cosmetically-appealing incisions, less post-operative pain, and shorter hospital stays [1,15,16,7,17,8,5,18,9,19,13,10,4,2 0,21]. However, complete endoscopic removal is technically more challenging in some cases than removal via open craniotomy, and recurrence rates may be higher [16,7,8,5,18,9,13,14]. Because open surgical procedures have low recurrence rates and acceptably low morbidity, it is the burden of endoscopic neurosurgeons to demonstrate that the endoscopic approach can yield similar success with long-term follow-up.

In previous studies, many colloid cysts do not recur at all after near total endoscopic resection [7,5,9,12,22,4]. When colloid cysts do recur after endoscopic removal, recurrence typically is noted between two and six years after surgery [1,2,17,19,13,14,20]. The earliest reported recurrence after endoscopic resection to date was eight months after surgery [19].

This case is noteworthy because of an unusually rapid recurrence after near-complete endoscopic resection of a large colloid cyst. This case is reported to alert neurosurgeons that recurrence can occur after near-total endoscopic resection of colloid cysts earlier than previous reports suggest and to add to the ongoing debate regarding the optimal means of managing these lesions.

Case Presentation

A 36 year-old man presented with an 18 month history of headaches occurring with increasing frequency and severity. A computed tomography (CT) scan demonstrated a lesion in the anterior third ventricle measuring greater than 2 centimeters in diameter. Magnetic resonance imaging (MRI) showed that the lesion had signal characteristics consistent with a colloid cyst (Figures 1a, 1b, 1c). The ventricles were not appreciably enlarged, and there was no trans-ependymal absorption of CSF.