This document discusses a colloid cyst found in the third ventricle of the brain. Key details include:
- Colloid cysts are non-neoplastic epithelial cysts typically located in the anterior roof of the third ventricle.
- Patients usually present in the third to fifth decade of life with symptoms of increased intracranial pressure like headache or visual disturbances.
- On CT, a colloid cyst appears as a hyperdense, round lesion in the characteristic location of the third ventricle roof.
- Surgical excision is the curative treatment, with the aim of relieving hydrocephalus and removing the cyst. The transcortical transventricular approach has a high epilepsy
21. § Non neoplastic
§ Epithelial lined cysts
§ Developmental
§ Usually asymptomatic
§ Presents in 3rd to 5th decade
§ Only 8% presents in Pediatric age
§ Very typical location – ANTERIOR PART OF Roof of 3rd Ventricle
§ Contains mucinous or viscous or solid contents
22. §CT– HYPERDENSE OR ISODENSE TO CSF
§ NOT ENHANCED BY CONTRAST
§ CALCIFICATIONS UNCOMMON
§ HYPERDENSE à SOLID CONTENT à DRAINING DIFFICULT
à REDUCED CAPACITY TO ENLARGE
§ DENSITY CORRELATES BETTER WITH VISCOSITY OF THE CONTENTS THAN MRI
§MRI – VARIABLE
§ MOST COMMONLY T1 – HYPERINTENSE
T2 – HYPOINTENSE
§ NOT CORRELATES WITH FLUID DENSITY OF CONTENTS
25. § HEADACHE – INTERMITTENT ; SOMETIMES POSITIONAL
§ Leaning head forward
§ DROP ATTACKS / LOC
§ VOMITING
§ GAIT DISTURBANCES
§ VISUAL DISTURBANCES – DIPLOPIA, PAPILLEDEMA, OPTIC CHIASMA
§ MEMORY LOSS
§ BEHAVIOUR CHANGES
§ FALSE LOCALIZING SIGNS
§ SUDDEN DEATH – ( HYDROCEPHALUS à CONING)
1/3
26.
27.
28. SURGICAL EXCISION IS CURATIVE
§IF PATIENT APPEARS OBTUNDED
§ URGENT VENTRICULAR DRAINAGE IS INDICATED; USUALLY REQUIRES
BILATERALLY
§IF NO NEUROLOGICAL DETERIORATION
AND PATIENT IS STABLE
§ VENTRICULAR DRAINAGE IS NOT INDICATED; BECAUSE ENLARGED VENTRICLES
CAN FACILITATE THE SURGICAL APPROACH.
29. SURGICAL EXCISION IS CURATIVE
§ FACTORS
§ SIZE à <7mm & INCIDENTAL à CONSERVATIVE
§ SYMPTOMS à IF PRESENT, SURGERY INDICATED
§ CONTENT à FLUID à ASPIRATION POSSIBLE
§MICROSURGICAL EXCISION
§ TRANSCORTICAL TRANSVENTRICULAR APPROACH à HIGH EPILEPSY RATE
§ INTERHEMISPHERIC TRANS-CALLOSAL APPROACH à AMNESIA
§ ENDOSCOPIC TRANSCORTICAL APPROACH à HIGH TECHNICAL FAILURE RATE
§STEREOTACTIC ASPIRATION à HIGH RECURRENCE RATE;
MINIMALLY INVASIVE;
RESERVED FOR ELDERLY
30. § 3RD TO 5TH DECADE
§ SYMPTOMS OF ACUTE HYDROCEPHALUS
( Headache ? POSITIONAL, LOC, visual disturbances etc.)
§ CT BRAIN showing
§ HYPERDENSE ( ISODENSE TO CSF SOMETIMES),
§ ROUND/OVOID LESION in this
§ LOCATION ( MIDLINE, ANTERIOR PART OF ROOF OF 3RD VENTRICLE )
IT IS ALMOST ALWAYS COLLOID CYST