Colloid Cysts
Colloid cysts are benign brain tumors that are usually located in the third ventricle. The cysts are comprised of epithelial lining filled with mucinous material. They grow slowly and can cause blockage of cerebrospinal fluid (CSF) that may result in the enlargement of one or both of the lateral ventricles, also known as acute obstructive hydrocephalus.
Colloid cysts are very rare. They account for less than two percent of all primary brain tumors. Although they can be found at any age, they are typically diagnosed in adults in their 30s and 40s. Most colloid cysts are currently discovered incidentally on imaging in asymptomatic patients. Patients who are symptomatic most commonly are seen in the emergency room or urgent care settings with complaints of severe headaches.
Mount Sinai Neurosurgery offers the ability to remove colloid cysts through a craniotomy and endoscopically. removal/resection, having one of the largest reported series of colloid cyst patients in the world who underwent complete endoscopic removal of their colloid cysts. Taking an interdisciplinary approach and working with team members from the departments of neurosurgery, neurology, radiation oncology, and rehabilitation medicine to ensure the highest quality care. Your colloid cyst will be managed by a specialized interprofessional team that includes neurosurgeons, neurologists, radiologists, and neuroscience NPs, PAs, and RNs.
Symptoms
Most commonly, patients are without symptoms, or asymptomatic, from their colloid cyst. These are patients discovered to have a colloid cyst only after a Magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain was performed to rule out other processes in the brain.
Usually, you do not experience any symptoms until they grow or press on surrounding structures.
You may experience the following symptoms:
- Headaches (most common)
- Gait changes
- Memory problems
- Dizziness
- Nausea/vomiting
- Vertigo
- Acute obstructive hydrocephalus
Acute Obstructive Hydrocephalus
Acute hydrocephalus can occur when the flow of CSF is blocked in one of the chambers, or ventricles in the brain. Ventricular blockage, or obstruction, can cause their enlargement which leads to increased pressure within the brain that can be life threatening. Colloid cysts typically grow in the third ventricle and can cause blockage one or both lateral ventricles. When patients have hydrocephalus related to their colloid cyst this can be considered a serious warning sign to have their colloid cyst treated promptly.
Rarely, colloid cysts have been reported to cause sudden death as a result of acute obstructive hydrocephalus.
Diagnosis and Treatment
Both CT and MRI are the preferred methods for imaging of colloid cysts. However, a CT of the head can be quickly obtained to identify acute hydrocephalus in patients with acute neurological deterioration. After life-threatening hydrocephalus is ruled out or treated, the clinician can focus on the management and treatment of the colloid cyst.
Asymptomatic Colloid Cysts
Patients who are living with colloid cysts and asymptotic do not necessarily warrant treatment if their colloid cyst is small (less than one cm) as colloid cysts that are smaller than one cm are less likely to cause ventricular obstruction and hydrocephalus.
Symptomatic Colloid Cysts
Patients who are living with colloid cysts and are symptomatic, especially if they developed associated hydrocephalus, are recommended treatment. The goal of surgery is complete removal of the colloid cyst capsule and its mucinous contents. If a portion of the colloid cyst is left behind, it can grow back and cause complications.
In certain instances, symptomatic colloid cysts in patients may be monitored over time with serial imaging to determine growth of the cyst as well as any evidence of hydrocephalus. Some colloid cysts in patients can be regularly watched for years to decades without any enlargement or associated symptoms.
The only treatment for a colloid cyst is surgical removal. The size, location, and presenting symptoms of the cyst will help determine the best course of surgical treatment. Patients are evaluated carefully to see if management, surgery, and which type of surgical approach is best.
Endoscopic Surgery
Mount Sinai has neurosurgeons who are experts at the removal colloid cyst resection via endoscopic technology. Making a tiny incision (two cm) in the upper forehead and a small hole in the skull (eight mm), a six mm endoscope (fiber optic camera) is advanced through the brain to get access to the lateral ventricle. The endoscope is then passaged into the opening of the third ventricle, removing the colloid cyst completely. Specially designed instruments are passaged along the shaft of the endoscope in order to completely remove the colloid cyst. The operation is generally one to two hours with most patients can be discharged within 48-72 hours after surgery, having made a full neurological recovery.
Craniotomy
A colloid cyst can be removed with a craniotomy, where part of the skull is removed for a duration of the surgery and then the skull is placed back. Depending on the size and location, open craniotomy approaches to access the colloid cyst are through the lateral ventricle or through the rostral end of the genu of the corpus callosum. Being more suitable for larger colloid cysts, craniotomies generally provide a lower recurrence and reoperation rate. The operation is generally three to four hours with most patients can be discharged within 48-72 hours after surgery, having made a full neurological recovery.
Complications
Your neurosurgeon and surgical team will discuss the risks and benefits with your surgery. While we will review your precise risks and benefits as they relate to your specific situation, general risks regarding treatment options for your colloid cyst are:
- Infection, that can result in meningitis
- Short term memory problems
- Bleeding at the incision site or in the brain requiring surgical evacuation
- Stroke that can result in paralysis or speech difficulties
- Hydrocephalus following surgery requiring the need for a ventriculoperitoneal shunt (VP shunt)
- Pain
- Reactions to general anesthesia
Recovery and Follow-Up
If needed, Mount Sinai offers acute rehab services that can help patients receive physical, occupational, and speech therapy. Follow-up appointments are usually scheduled a week or two after you leave the hospital, with sutures being absorbable, so they do not need to be removed.