Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle: Clinical article

Scott Shapiro, Richard Rodgers, Mitesh Shah, Daniel Fulkerson, Robert L. Campbell

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Object. Endoscopic surgery has been reported to be more cost-effective and safer than open craniotomy for resection of colloid cysts, despite a 5-10% conversion rate to craniotomy, a 5% recurrence rate, a 5-10% ventricular shunting rate, a 5-10% epilepsy rate, and a 3-4 day hospital stay. In 1985, the authors developed a interhemispheric, transcallosal, subchoroidal, fornix-sparing approach that allowed safe total resection of the colloid cyst and that appeared to be superior to the endoscopic approach. The long-term results are analyzed and compared with findings in the literature. Methods. Fifty-seven consecutive colloid cysts were totally removed via a 3 x 3-in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix . The length of the callosotomy was 1.5-2 cm in all patients. The mean follow-up duration was 12 years (range 2-22 years). A retrospective analysis comparing the authors' results with those reported in the endoscopic literature was performed. Results. All patients had 1-year postoperative imaging studies (CT or MR imaging) documenting gross-total resection with no deaths, infection, hemiparesis, seizures, or disconnection syndrome. One surgery was complicated by bilateral subdural hematomas, which were successfully treated. There has been a zero recurrence rate. Three patients required a permanent ventriculoperitoneal shunt (including 2 who required emergency ventriculostomy before surgery). The mean hospital stay was 4.8 days (range 2-24 days). There was 1 patient with permanent short-term memory loss who presented with a herniation syndrome requiring emergency ventriculostomy. Conclusions. The interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts is safe and led to a zero recurrence rate with no permanent neurological sequelae including epilepsy, and these results are superior to any reported results with endoscopy.

Original languageEnglish (US)
Pages (from-to)112-115
Number of pages4
JournalJournal of neurosurgery
Volume110
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Colloid Cysts
Craniotomy
Ventriculostomy
Recurrence
Epilepsy
Length of Stay
Emergencies
Ventriculoperitoneal Shunt
Subdural Hematoma
Memory Disorders
Paresis
Short-Term Memory
Endoscopy
Seizures
Costs and Cost Analysis
Colloid cysts of third ventricle
Infection

Keywords

  • Colloid cyst
  • Craniotomy
  • Fornix
  • Neuroendoscopy
  • Subchoroidal approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle : Clinical article. / Shapiro, Scott; Rodgers, Richard; Shah, Mitesh; Fulkerson, Daniel; Campbell, Robert L.

In: Journal of neurosurgery, Vol. 110, No. 1, 01.01.2009, p. 112-115.

Research output: Contribution to journalArticle

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abstract = "Object. Endoscopic surgery has been reported to be more cost-effective and safer than open craniotomy for resection of colloid cysts, despite a 5-10{\%} conversion rate to craniotomy, a 5{\%} recurrence rate, a 5-10{\%} ventricular shunting rate, a 5-10{\%} epilepsy rate, and a 3-4 day hospital stay. In 1985, the authors developed a interhemispheric, transcallosal, subchoroidal, fornix-sparing approach that allowed safe total resection of the colloid cyst and that appeared to be superior to the endoscopic approach. The long-term results are analyzed and compared with findings in the literature. Methods. Fifty-seven consecutive colloid cysts were totally removed via a 3 x 3-in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix . The length of the callosotomy was 1.5-2 cm in all patients. The mean follow-up duration was 12 years (range 2-22 years). A retrospective analysis comparing the authors' results with those reported in the endoscopic literature was performed. Results. All patients had 1-year postoperative imaging studies (CT or MR imaging) documenting gross-total resection with no deaths, infection, hemiparesis, seizures, or disconnection syndrome. One surgery was complicated by bilateral subdural hematomas, which were successfully treated. There has been a zero recurrence rate. Three patients required a permanent ventriculoperitoneal shunt (including 2 who required emergency ventriculostomy before surgery). The mean hospital stay was 4.8 days (range 2-24 days). There was 1 patient with permanent short-term memory loss who presented with a herniation syndrome requiring emergency ventriculostomy. Conclusions. The interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts is safe and led to a zero recurrence rate with no permanent neurological sequelae including epilepsy, and these results are superior to any reported results with endoscopy.",
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N2 - Object. Endoscopic surgery has been reported to be more cost-effective and safer than open craniotomy for resection of colloid cysts, despite a 5-10% conversion rate to craniotomy, a 5% recurrence rate, a 5-10% ventricular shunting rate, a 5-10% epilepsy rate, and a 3-4 day hospital stay. In 1985, the authors developed a interhemispheric, transcallosal, subchoroidal, fornix-sparing approach that allowed safe total resection of the colloid cyst and that appeared to be superior to the endoscopic approach. The long-term results are analyzed and compared with findings in the literature. Methods. Fifty-seven consecutive colloid cysts were totally removed via a 3 x 3-in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix . The length of the callosotomy was 1.5-2 cm in all patients. The mean follow-up duration was 12 years (range 2-22 years). A retrospective analysis comparing the authors' results with those reported in the endoscopic literature was performed. Results. All patients had 1-year postoperative imaging studies (CT or MR imaging) documenting gross-total resection with no deaths, infection, hemiparesis, seizures, or disconnection syndrome. One surgery was complicated by bilateral subdural hematomas, which were successfully treated. There has been a zero recurrence rate. Three patients required a permanent ventriculoperitoneal shunt (including 2 who required emergency ventriculostomy before surgery). The mean hospital stay was 4.8 days (range 2-24 days). There was 1 patient with permanent short-term memory loss who presented with a herniation syndrome requiring emergency ventriculostomy. Conclusions. The interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts is safe and led to a zero recurrence rate with no permanent neurological sequelae including epilepsy, and these results are superior to any reported results with endoscopy.

AB - Object. Endoscopic surgery has been reported to be more cost-effective and safer than open craniotomy for resection of colloid cysts, despite a 5-10% conversion rate to craniotomy, a 5% recurrence rate, a 5-10% ventricular shunting rate, a 5-10% epilepsy rate, and a 3-4 day hospital stay. In 1985, the authors developed a interhemispheric, transcallosal, subchoroidal, fornix-sparing approach that allowed safe total resection of the colloid cyst and that appeared to be superior to the endoscopic approach. The long-term results are analyzed and compared with findings in the literature. Methods. Fifty-seven consecutive colloid cysts were totally removed via a 3 x 3-in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix . The length of the callosotomy was 1.5-2 cm in all patients. The mean follow-up duration was 12 years (range 2-22 years). A retrospective analysis comparing the authors' results with those reported in the endoscopic literature was performed. Results. All patients had 1-year postoperative imaging studies (CT or MR imaging) documenting gross-total resection with no deaths, infection, hemiparesis, seizures, or disconnection syndrome. One surgery was complicated by bilateral subdural hematomas, which were successfully treated. There has been a zero recurrence rate. Three patients required a permanent ventriculoperitoneal shunt (including 2 who required emergency ventriculostomy before surgery). The mean hospital stay was 4.8 days (range 2-24 days). There was 1 patient with permanent short-term memory loss who presented with a herniation syndrome requiring emergency ventriculostomy. Conclusions. The interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts is safe and led to a zero recurrence rate with no permanent neurological sequelae including epilepsy, and these results are superior to any reported results with endoscopy.

KW - Colloid cyst

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KW - Neuroendoscopy

KW - Subchoroidal approach

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