APPROACHES TO COLLOID

CYST (OF 3RD VENTRICLE)

Hardik

ANATOMY
Colloid cysts are located inside the
third ventricular cavity
most often in its anterior-superior
compartment.
The upper anterior part of the cyst
is exposed at the foramina of
Monro.

ANATOMY
orientation of the plane of the foramen of
Monro:
represented by its circumference,
It is oblique
Tilting laterally and anteriorly.
medial and posterior parts are located higher
than the lateral and anterior borders.

ANATOMY
The fornix, the choroid plexus, and
the veins of the venous angle are
often displaced in a manner that
leads to enlargement of the
foramen.
It may also be narrowed or rarely,
practically occluded

CHOOSING THE TYPE OF SURGERY

Stereotactic aspiration : without any
visual control.
Consistency of the cyst is not always
predictable from imaging.
Risk of injury to adjacent vascular
structures.
Incomplete or failed aspirations are
reported.
Excision of the wall is not possible.

TOTAL NO. OF
PATIENTS

26

COMPLETE ASPIRATION

17

PARTIAL ASPIRATION

06

FAILED ASPIRATION

03

SYMPTOMATIC
RECURRENCE

05/06, 04/17.

TIME TO RECURRENCE ON
IMAGING

42MONTHS

TIME TO SYMPTOMATIC
RECURRENCE

184MONTHS

STEREOPSIS

ENDOSCOPE

MICROSCOPE

NON STEREOSCOPIC VISION

STEREOSCOPIC VISION

MONOCULAR VISION

BINOCULAR VISION

ONE HANDED MANIPULATION

TWO HANDED MANIPULATION

BLEEDING : VISIBILITY AND

HEAMOSTASIS ISSUES

BETTER MANAGED

LESS MANIPULATION OF
NORMAL BRAIN

MORE MANIPULATION

PANAROMIC VIEW

TUBULAR VIEW

WIDER AND EASILY OBTAINED

RANGE OF TRAJECTORIES

LIMITED MOVEMENT

WHICH IS BETTER ?
No ONE is better !
Latest and (probably) wisest is :
ENDOSCOPIC ASSISTED
MICROSCOPIC

MICROSURGICAL
APPROACHES
The transcortical-transventricular
approach
The transcallosal-transventricular
approach

 The most commonly used approach

for solely intraventricular lesions is
probably the transcorticaltransventricular approach
Described by Dandy

Advantages of the
transcallosal
Anatomy is constant.
Distance to 3rd V. is shorter
Depths of anterior part can be
accessed
No cortical incision
Ventricle size doesn't matter
Choice of right or left monero

Advantages of the
transcortical
Less chance of compromising an
essential draining veins going to SSS
Less chance of injuring the
pericallosal arteries

 Transcortical-Transventricular
Approach

 Thank You !

 The distinction between masses

arising within and expanding the
third ventricle and those impinging
from outside is important for
determining the best operative
approach.
How to differentiate between the
two..
Clinical/imaging/angio

 If the lesion in the vicinity of the

anterior third ventricle is small, the
approach is best determined by the
presence or absence of a visual field
disturbance.
If the ventricles are enlarged,
transventricular (TV)is better, but
vision into the depth of anterior third
ventricle is difficult with this,
transcallosal (TC) is better for that.

 If the ventricles are small the

transcallosal approach is far superior.