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Colloid cyst in the 3rd ventricle - endoscopic excision Hot

Colloid cyst in the 3rd ventricle - endoscopic excision
Colloid cyst in the 3rd ventricle - endoscopic excision
Colloid cyst in the 3rd ventricle - endoscopic excision

Colloid cyst in the 3rd ventricle - endoscopic excision by Dr Antonio Romano and Dr Angelo Murgese, Parma, Italy.

Anterior endoscopic transfrontal approach to the third ventricle.

Man, 38 years old, GCS 4 before surgery, midriatic pupils and with acute hydrocephalus at the CT scan. In Emergency we placed a bilateral external ventricular drainage obtaining the regression of the midriasis and the best motor answer was in flexion. The MRI shown a large cyst with a solid part bilateral ischemia of thalamus and of the brain stem cause of brain herniation.

We performed the operation on 3th days from the access using anterior stereotatic mire on the foramen of Monro. Skin incision was performed 1,5 cm on the right frontal wrinkle with stereotatic references. We made the burr hole following the stereotatic coordinate and inserted the catheter. On this catheter we inserted the peel away until 1 cm from the entrance avoiding to damage the fornix.The peel away was fixed and the catheter removed. We proceeded introducing the rigid endoscope 30°optic and identified the cystic wall covered by the plexus and we started to coagulate it. After that we employed the diode laser (20W) on the cystic wall open and emptied by the liquid part. To removing the solid part we used a small catheter and water washing out with pressure, obtaining the fragmentation of the hard colloidal part and the dissection of the structures. Finally we coerced the cystic wall until to identify the residual part adherent to the plexus and thela chorioidea. At the end we verified the patency of the aqueduct and the internal cerebral veins were visible. At this point we perform ever the prior septostomy to avoid the monoventricular hydrocephalus.

The post-operative CT scan showed a good result, but the patient presents a vegetative state.


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Click here to read more about Colloid cysts.

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