Endoscopic Transcortical Tubular-Based Resection of a Third Ventricle Colloid Cyst: Two-Dimensional Operative Video.

Abstract

We present a case of third ventricle colloid cyst surgical resection using a tubular-based endoscopic transcortical approach. Third ventricle colloid are rare benign lesions typically found in the anterolateral part of the third ventricle, close to the foramen of Monro.¹ Several surgical approaches have been employed for their management.^2-4 Tubular retractors have been introduced in the neurosurgical practice for their ability to minimize retraction-related injury by distributing retraction forces radially.^5-7 A 35-year-old male with a history of multiple sclerosis presented with severe headache and dizziness. Neuroimaging revealed the presence of left ventricular enlargement. Lesion exhibited a homogeneously high magnetic resonance imaging T2 weighted/T2 weighted fluid attenuated inversion recovery signal with and peripheral enhancement indicative of a colloid cyst. Colloid cyst localized in zone I of the Beaumont classification. A left small frontal craniotomy was performed. A 17-mm diameter ViewSite Brain Access System (Vycor Medical Inc., Boca Raton, Florida, USA) tubular retractor was guided into the left lateral ventricle under neuronavigation. Following controlled decompression of the mucinous content, the cyst capsule was progressively mobilized from critical neurovascular structures and removed. Free communication of the ventricular system was confirmed; therefore, no further maneuver was necessary. No postoperative complications were observed during the postoperative course. Postoperative magnetic resonance imaging on first month confirmed the gross total resection and resolution of hydrocephalus. The endoscopic transcortical tubular-based approach is an effective and safe method for treating colloid cysts. This approach offers the advantages of minimal invasiveness, optimal visualization, and reduced tissue manipulation, establishing a valid method in the management of colloid cysts in the third ventricle.