This document discusses a 47-year-old male patient who presented with intermittent headaches and impaired recent memory over the past 3 months. CT scanning revealed a colloid cyst in the anterior third ventricle. The patient underwent an endoscopic resection of the colloid cyst. Post-operatively, the patient's neurological condition was good and his memory disorder had resolved by the 3-month follow up appointment.

2. DR USMAN HAQQANI
RESIDENT NEUROSURGERY B
LADY READING HOSPITAL
PESHAWAR

3.  History
47 years old gentleman had intermittent
headache and impaired recent memory
from 3 months and gradually his
symptoms accelerated.

4.  Clinical examination
revealed no focal neurological
signs but loss of recent memory
was present.
 Eye examination

5.  CT was Advised

6.  Still in doubt ?

8.  Diagnosis ?

11.  The patient discharged with good
neurological condition 0n 6th postoperative
day.
 At the 3rd month of follow up, the patient
did not show any focal neurological
deficite and memory disorder was
remitted.
********

12.  Colloid cysts are benign, congenital
epithelium-lined cysts that almost always
arise in the anterior third ventricle.
 Colloid cysts of the third ventricle are located
at the level of the foramin of monro.
 Attached to the roof or floor, fornix, or the
choroid plexus.
 Size range from few mm to several cm.
 Small ones may be asymptomatic.
 Histology consists of pseudo stratified
columnar or cuboidal epithelium.

13.  0.5-1 % of intracranial tumors.
 15 to 20% of Intraventricular mass
 Female= Male
 Incidence:
 General population: 3/100,0000/year
 Age:
 Common in adults
 Range: 20-30 years.

14.  Colloid cyst
 IST REPORTED.
▪ By Wallman in 1858
 IST OPERATED.
▪ By Dandy in 1921.
▪ In 1983, Pawer et al reported the first
successful endoscopic aspiration of a third
ventricle colloid cyst

16.  Presentation in childhood is rare. The tumors are
usually symptomatic in patients aged 20-50 years
 Common Symptoms include:
 Intracranial hypertension.
 paroxysmal headache
 progressive headache
 Drop attacks
 severe cases, coma or even death can occur.

17.  Impaired memory.
 Visual impairment.
 Papilloedema.
 Gait abnormalities.
 Sudden LOC.
 Sudden death.
 Asymptomatic
 seizures

18. 1. Computed tomography.
2. Magnetic resonance imaging.

19.  On CT colloid cyst
appear as rounded or
oval lesion in the
anterior and superior
areas of 3rd ventricle
at the level of
foramina of Monro.
 Hypo or hyperdence
to brain with minimal
to no enhancement
in its wall

20.  MRI:
 Three dimensional,
multiplanar.
 Exact tophography.
 Preoperative surgical
planning.
 Differentiates cysts
from tumors.
 Hyperintense on T1WI
 Hyperintense on T2WI.
 MRA:
 Replaced the DSA.

21.  Intra ventricular meningeoma
 Neurocysticercotic cyst
 Subependymoma
 Choroid plexus papilloma

23.  Transcranial
1. Trans cortical, trans ventricular
approach( Frontal lobe)
2. Trans callosal approach.
 Endoscopic aspiration/ excision
 Sterotaxic aspiration

24.  Neurological deterioration occures in a
small number of patients but high risk
patients may not be identified
 Therefore, the mere surveillance is
justified only
 in the elderly
 in those with low life expectancy
 those with increased anesthetic risk

25.  Recommended for Removal
 Symptomatic patient
 Ventriculomegaly
 Progressive size
 Cyst size >1cm

26.  is safe and effective for treatment of
colloid cyst of third ventricle
 provides good optical resolution and high
magnification, through which total or near
total resection can be achieved
 Decreased hospital stay, more rapid
return to active life , low direct surgical
morbidity and resolution of symptoms

27.  Disadvantage
 requires experience.
 Cyst location and degree of distension of the third
ventricle roof may cause problems when using a
rigid endoscope
 Traction on adherent ceiling remains of the
capsule may lead to bleeding
 A major bleeding can blur the image and can be
difficult to stop using the available specific tools.
 not always the colloid cyst can be completely
removed.

28.  Cyst >2cm may compromise and adhere
to the fornix and maybe more safely
removed using microscopic bimanual
disection
 If imaging predicts consistensy of cyst to
be hard and cheesy
 Transcallosal approach is used especially
in the absence of ventriculomegaly.

29.  Fornix lesions by the manipulation of
instruments
 thermal damage by excessive
coagulation
 intraoperative bleeding
 aseptic or septic ventriculitis are potential
complications of endoscopic surgery
 Overall morbidity is transient.

30. THANK YOU