Abordajes Neurocirugia

TUMOR

Operative Technique

Supraorbital Endoscopic Approach to Colloid Cysts
Alberto Delitala, MD
Andrea Brunori, MD
Natale Russo, MD
Department of Neurological Sciences,
Neurosurgery, S. Camillo-Forlanini
Hospital, Rome, Italy
Correspondence:
Natale Russo, MD,
S. Camillo-Forlanini Hospital
Viale Gianicolense,
Rome, Italy.
E-mail: natale-russo@libero.it
Received, July 14, 2010.Accepted, February 9, 2011.
Published Online, April 5, 2011.
Copyright ª 2011 by the
Congress of Neurological Surgeons

BACKGROUND: Surgical approaches to colloid cysts of the third ventricle have evolved
over time. In recent years, endoscopy has been recognized as an effective alternative to
open surgery. The disadvantage of endoscopic treatment is the difficulty in controlling
theadhesion of the cyst to the roof of the third ventricle and in obtaining complete
removal of the cyst.
OBJECTIVE: To design and carry out a supraorbital approach to obtain a better viewing
angle of the cyst and better control of the adhesion of the cyst to the roof of the third
ventricle.
METHODS: From September 2005 to February 2008, we operated on 7 consecutive
patients with colloid cysts inthe third ventricle. All procedures were performed with the
endoscopic supraorbital approach. The endoscopic procedure was performed with
a rigid STORZ endoscope with 3 working channels. In 4 patients, the surgical supraorbital
trajectory was planned with the help of a navigator.
RESULTS: The procedures lasted between 60 and 110 minutes, including the registration
on the navigation system.Near-total removal of the cyst was achieved in 6 patients. All
patients were discharged within 6 days.
CONCLUSION: Endoscopic treatment may be an effective and safe alternative to open
surgical craniotomy. Our series shows that the endoscopic supraorbital endoscopic
resection is a valuable approach to colloid cysts of the third ventricle.
KEY WORDS: Colloid cyst, Endoscopy, Supraorbital approach,Third ventricle
Neurosurgery 69[ONS Suppl 2]:ons176–ons183, 2011

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he origin and natural history of colloid cysts
are debated topics. Some authors suggest
that ectoblastic residuesare the common
precursor of colloid cysts, Rathke cleft cysts, and
neuroenteric cysts.1 The natural history of colloid
cysts has been depicted,2 and in some cases, urgent
surgery is necessary. Since the first excision of
a colloid cyst by Dandy in 1920, surgical techniques have evolved. Classic surgical routes include
the transcallosal and transcortical transventricular
approaches, and even asuboccipital supratentorial
approach has been described.3 The largest surgical
series report an acceptable rate of morbidity and
mortality.4-6 In recent years, endoscopy has been
recognized as an effective alternative to open surgery.7-10 The perfect illumination and

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ons176 | VOLUME 69 | OPERATIVE NEUROSURGERY 2 | DECEMBER 2011

DOI: 10.1227/NEU.0b013e318219563c

magnification achievable with an endoscopic approach are extremely useful in deep-sited surgery
such as in the third ventricle. Some recent articles
have reported a very low rate ofmortality and
complications in endoscopic series.8,11 Compared
with endoscopic approaches, a higher complication
rate has been reported among patients treated with
microsurgical techniques11,12 with an increased
risk of postoperative seizure, hemiparesis, venous
infarction, and cognitive impairment.13 The main
disadvantage of endoscopic treatment, performed
through a classic precoronal route,...