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Colloid Cyst - Image of the Week
- 1. By Dr. K. Manievelraaman Firstyear PG IIM, MMC & RGGGH. Prof. Dr. R. Penchalaiah Unit M2
- 3. § Patient conscious,oriented. § CVS – S1S2 + § RS – NVBS § PER ABDOMEN – SOFT, NO ORGANOMEGALY § CNS – B/L PUPIL SLUGGISHLY REACTIVE TO LIGHT § EXTRAOCULAR MOVEMENTS – FULL § B/L PLANTAR FLEXOR § BREATHING SPONTANEOUSLY § MOVES ALL 4 LIMBS
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- 11. HYPERDENSE HOMOGENOUS WELL DEMARCATED ROUND SMOOTH BORDERS UNILOCULAR MIDLINE TYPICALLOCATION VENTRICULOMEGALY
- 14. USUALLY NO § LARGEBASILAR TIP ANEURYSM § MRI TO DIFFERENTIATE § NEUROCYSTICERCOSIS § PRESENCE OF SCOLEX
- 15. §Non enhancing §Well demarcated §Roundor ovoid §Thin walled
- 16. §Hypodense in CT §Hypointenseon T1 WI §Hyperintense on T2WI §Hypoechoic on USG with Acoustic enhancement
- 17. §ARACHNOID CYST §COLLOID CYST §DERMOIDCYST §EPIDERMOID CYST NON NEOPLASTIC
- 18. ARACHNOID CYST MIDDLE CRANIALFOSSA DERMOID CYST TYPICALLY MIDLINE POSTERIOR CRANIAL FOSSA EPIDERMOID CYST CP ANGLE
- 19. COLLOID CYST A FEWWORDS ABOUT
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- 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 ORISODENSE 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
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- 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
- 28. SURGICAL EXCISION ISCURATIVE §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 ISCURATIVE § 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 TO5TH 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