Peer-Review ReportEndoscopic Versus Microsurgical Resection of Colloid Cysts: A Systematic Review and Meta-Analysis of 1278 Patients
Introduction
Colloid cysts of the third ventricle are benign tumors that are thought to have a neuroectodermal origin 53, 57. These cysts arise from the roof of the third ventricle in close proximity to the interventricular foramen of Monro, typically obstructing the flow of cerebrospinal fluid (CSF) leading to hydrocephalus or in extreme cases sudden death 1, 10, 16, 53, 59. Colloid cysts are noted to have a thin collagen wall lined with a single layer of cuboidal epithelium that is ciliated and/or nonciliated 1, 26, 53, 57. Cyst contents are typically characterized by a mucinous suspension ranging in dark green to brown color, occasionally being solid (26). The incidence of colloid cyst ranges from 0.5% to 2.0% of all intracranial tumors 29, 31, 53, 57. Surgical resection is often chosen for large symptomatic colloid cysts, whereas small asymptomatic lesions can be managed by close observation with serial magnetic resonance imaging (MRI) 45, 46, 59. Currently, surgical interventions include CSF shunting, cyst aspiration, microsurgical resection, and more recently, endoscopic resection 19, 34, 41, 53.
Simple decompression of the cyst contents without complete removal of the cyst wall often results in recurrence, previously reported by Mathiesen et al. 41, 42, at a rate of 80% (27). Therefore, radical removal of the cyst wall and intracystic contents is necessary to minimize recurrence 27, 41. Traditionally, transcortical or transcallosal microsurgical approaches with a craniotomy have been the mainstay for surgical treatment of colloid cysts. This approach provides excellent access to the third ventricle and foramen of Monro, and allows for bimanual microdissection of the cyst wall from the critical structures such as the fornix, choroid plexus, and internal cerebral vein 6, 25, 49. However, one disadvantage may be the risk of postoperative morbidities associated with a craniotomy 21, 53. Recently, there has been increased interest in endoscopic approaches for colloid cyst resection because some investigators believe that it is a less invasive technique than traditional microsurgical approaches, which may potentially minimize postoperative complications and perioperative morbidity 1, 7, 9, 11, 14, 23, 24, 30, 41, 52, 59. One major criticism of the standard single-burr hole endoscopic approach is the inability to perform bimanual microdissection of the cyst wall from the critical structures as this technique relies on cyst wall aspiration followed by coagulation of the residual cyst wall remnants (28). The presence of residual cyst wall increases the risk of future recurrence 7, 11, 20, 23, 48, 59. Microsurgical series have typically reported higher rates of complete resection, whereas endoscopic series have reported shorter hospital stays and decreased complication rates 21, 32, 49, 50, 59.
Currently, there is no consensus on which surgical intervention is the most effective. In the present study, we analyzed the differences in endoscopic and microsurgical management of colloid cysts of the third ventricle by performing a systematic review and meta-analysis on the current literature, focusing on the extent of resection, morbidities, recurrence rates, and shunt dependency.
Section snippets
Literature Search Strategy
A systematic review of published literature on cases of colloid cysts was performed. The PubMed database was searched from 1990 to 2014 for “Colloid Cysts” and “Colloid AND cyst AND resection.” Article titles were scanned to identify studies that included colloid cyst treatment data. Abstracts were then reviewed, followed by close inspection of acquired full-text articles. Finally, the bibliographies of the retrieved articles were examined for additional studies missed from the original PubMed
Results
Searching the PubMed database using the key words and manual bibliography search identified 773 studies (Figure 1). Exclusion criteria included studies published before 1990 (292), non-English language (150), nonsurgical (106), not third ventricular colloid cyst (64), non-human subject (35), insufficient data (23), could not locate (18), type of surgical technique (15), insufficient outcome or follow-up data (14), unextractable data (10), and different diagnosis (6). After using the previously
Discussion
In the present systematic review and meta-analysis, 1278 patients who underwent surgical treatment for colloid cyst of the third ventricle were grouped into either microsurgical or endoscopic resection. It was found that the microsurgical group had a significantly greater extent of resection, lower rates of recurrence, and lower rates of reoperation than the endoscopic group. Both groups had similar rates of mortality and shunt dependency. The overall complication rate was lower in the
Conclusion
In the present study, the microsurgical removal of colloid cysts appears to result in a significantly higher rate of complete radical resection, decreased rate of recurrence, and fewer reoperations than with endoscopic removal. This may be related to the advantage of performing 2-handed microdissection of the cyst wall from critical adherent structures to achieve true GTR. The rate of mortality and shunt dependency is similar between both groups. The overall morbidity rate is lower in the
References (59)
- et al.
Surgical management of colloid cyst of the third ventricle—a study of 105 cases
Surg Neurol
(2002) - et al.
Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach—experience of 134 patients
Surg Neurol
(2008) - et al.
Colloid cyst of the third ventricle: a clinical review of 39 cases
J Clin Neurosci
(2001) - et al.
Endoscopic technique in the treatment of patients with colloid cysts of the third ventricle. Report based on over a decade of experience
Neurol Neurochir Pol
(2012) - et al.
Endoscopic treatment of intraventricular cystic tumors
World Neurosurg
(2013) - et al.
Neuroendoscopic colloid cyst resection: a case cohort with follow-up and patient satisfaction
World Neurosurg
(2014) - et al.
Endoscopic treatment of colloid cysts of the third ventricle. Technical note and review of the literature
J Neurosurg
(1998) - et al.
Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix
Brain
(2000) - et al.
Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research
J Eval Clin Pract
(2012) - et al.
Colloid cysts of the third ventricle: endoscopic versus microsurgical removal
Neurosurg Quart
(2010)
Stereotactically guided microsurgical removal of colloid cysts
Acta Neurochir (Wien)
Complete microsurgical resection of colloid cysts with a dual-port endoscopic technique
Neurosurgery
Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases
Neurosurgery
Stereotactic microsurgical craniotomy for the treatment of third ventricular colloid cysts
Neurosurgery
Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study
Neurosurg Rev
Colloid cysts
J Neurosurg
Endoscopic management of colloid cysts
Neurosurgery
Endoscopic surgery of third ventricle lesions [in French]
Neurochirurgie
Evaluating non-randomised intervention studies
Health Technol Assess
Stereotactic endoscopic treatment of colloid cysts of the third ventricle
Acta Neurochir (Wien)
Supraorbital endoscopic approach to colloid cysts
Neurosurgery
Interhemispheric and percallosal (transcallosal) approach to the cingulate gyri, intraventricular shunt tubes, and certain deeply placed brain lesions
Neurosurgery
Stereotactically guided endoscopic port surgery for intraventricular tumor and colloid cyst resection
Neurosurgery
Colloid cyst of the third ventricle. Evaluation of 28 cases of colloid cyst of the third ventricle operated on by transcortical transventricular (25 cases) and transcallosal/transventricular (3 cases) approaches
Acta Neurochir (Wien)
Purely endoscopic resection of colloid cysts
Neurosurgery
Endoscopic versus microsurgical resection of third ventricle colloid cysts
Can J Neurol Sci
Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance
Neurosurgery
Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade
Neurosurgery
Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcallosal microsurgery
Surg Neurol
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.