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Practical, Stereotactic, Low-Profile Technique for Transcortical/Transventricular Colloid Cyst Removal Independent of
Viktoria Sefcikova1,2, Queenie Hoi-Wing Wong3,4, George Samandouras1,4
1UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK.
Background:
In the presence of a dilated foramen of Monro, a transcortical, transforaminal approach is considered the safest and simplest approach for resection of colloid cysts. However, in the presence of small or normal frontal horns, numerous microsurgical approaches and, often complicated, variations have been described, invariably employing forms of stereotactic navigation.
Objective:
To report an alternative, accurate, microsurgical stereotactic low-profile technique.
Methods:
The small frontal horn is stereotactically targeted as previously described. Routine equipment is used to accurately create a novel, rigid, atraumatic surgical corridor.
Results:
After a 7-mm corticotomy, a peel-away catheter carrying the AxiEM stylet engages the target set as the frontal horn. All joints of the endoscope holder are locked, allowing only catheter advancement (y axis) while lateral (x axis) or anteroposterior (z axis) movements are secure. Two, 7-mm retractor blades are inserted. The extremely consistent anatomy of the foramen of Monro allows en bloc microsurgical removal without unnecessary coagulation of cyst wall or choroid plexus.
Conclusion:
Despite a plethora of approaches to the rostral third ventricle, in the presence of normal or small frontal horns, including creation of transcallosal/interforniceal, suprachoroidal (or transchoroidal), and sub-choroidal, colloid cyst resection does not necessarily need to be convoluted. Technical nuances of an accurate, practical, minimally invasive technique are described.
Insights
This study presents a novel, low-profile microsurgical technique for colloid cyst resection in cases with small frontal horns. This minimally invasive approach offers an accurate and practical alternative for neurosurgical procedures.
Area of Science:
- Neurosurgery
- Microsurgery
- Neuroanatomy
Background:
- Resection of colloid cysts can be challenging with small or normal frontal horns.
- Existing microsurgical approaches often involve complex variations and stereotactic navigation.
Purpose of the Study:
- To introduce an alternative, accurate, microsurgical stereotactic low-profile technique for colloid cyst resection.
- To describe technical nuances of a practical, minimally invasive approach.
Main Methods:
- Stereotactic targeting of the small frontal horn using routine equipment.
- Creation of a novel, rigid, atraumatic surgical corridor with a peel-away catheter and AxiEM stylet.
- Utilizing a locked endoscope holder for precise instrument control during advancement.
Main Results:
- A 7-mm corticotomy allowed engagement of the frontal horn target.
- Insertion of two 7-mm retractor blades created the surgical corridor.
- En bloc microsurgical removal of colloid cysts was achieved without damaging surrounding structures like the choroid plexus.
Conclusions:
- Colloid cyst resection in the presence of normal or small frontal horns does not require convoluted techniques.
- The described low-profile technique provides an accurate and practical minimally invasive option.
- This method simplifies colloid cyst removal, avoiding unnecessary coagulation.
