Endoscopic Bimanual Resection of Recurrent Colloid Cyst

Colloid cysts are nonneoplastic epithelial lesions arising from the roof of the third ventricle near the foramen of Monro. They comprise approximately 0.5% to 2% of all brain lesions.^1-3 Surgical resection is the definitive treatment when indicated. The microsurgical approach is generally considered the "gold standard," but the endoscopic approach has been gaining popularity.^4-6 The choice is usually based on a surgeon's preference and key image findings such as the presence of hydrocephalus. The advantage of an endoscopic approach is shorter operative time, faster recovery, and a more anterolateral approach to avoid manipulation on the fornix. The major drawback of the endoscopic approach was previously reported as a higher recurrence rate due to incomplete removal of the cyst capsule. However, it has been shown that the rate of capsule excision may be similar to that of microsurgery, ranging from 80 to 100%.^7-14 The authors demonstrate an endoscopic resection of a recurrent colloid cyst with bimanual technique through parallel channels in a ventriculoscope. Video 1 highlights the critical steps involved in preserving both vascular and neural structures during the procedure.