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Colloid cyst: Transcortical Approach

February 03, 2014


Here is a resection of a colloid cyst via the transcortical transsphenoidal approach using the tubular retractor systems. This is a 47-year old female who presented with severe headache and was noted to be suffering from a mild amount of hydrocephalus with a colloid cyst at the level of the foramen of Monro. The left lateral ventricle appeared larger, in addition to the left frontal horn of the lateral ventricle appeared larger and therefore a left transspenoidal approach was utilized. Here's a small left frontal craniotomy. There are various tubular retractor systems that can be used. Neuronavigation was also employed. Here's the cruciate dural incision, small cardiectomy. First, navigation guided placement of an external ventricular drain into the frontal horn of the lateral ventricle. A small amount of brain around the catheter was removed so that the tubular system can be inserted without significant resistance. Here's the entry into the frontal horn of the lateral ventricle and the transcortical disruption of the brain is relatively minimal. 14 millimeter diameter tubular retractor system was used and fixed in position. Here's a view toward the foramen of Monro, septal vein is apparent. Choroid plexus. Initially, very minimal amount of the cyst is actually visible until the choroid plexus is mobilized more posteriorly. Binated instruments are used. This is the foramen of Monro. The cyst apparent. Small carotenoid patty was used to mobilize the fornix medially. The choroid plexus overlying the cyst was coagulated. The cyst then entered and debunked. Here you can see a section of the contents of the cyst. Third ventricle and its floor are apparent. But the most critical part is disconnection of the superior capsule of the tumor from the roof of the third ventricle. There are often choroidal feeding vessels to the capsule. The tumor did have to be carefully coagulated and cut. In addition, here's the operative blind spot just along the posterior aspect of our dissection where a small piece of capsule can be left behind. I continue my dissection over the capsule of tumor, so that the cyst is removed in block and no residual piece of the tumor is left behind. Some of the feeding vessels to the capsule are identified, sharply cut and the entire capsule of the cyst is extracted. In this case the cyst was slightly adherent to the wall of the third ventricle. I can see the floor of the third ventricle. The cysts were removed in block. Further inspection revealed no residual cysts. And the postoperative MRI confirmed gross total removal of the mass with resolution of the hydrocephalus. You can see really minimal transgression of the brain through the fibers of the left frontal lobe. This patient's headaches resolved after surgery. Thank you.

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