Colloid cysts …

Ka-Wai Grace Ho MD

Neuro-Oncology

Updated 06.24.2024
Released 03.25.1996
Expires For CME 06.24.2027

Colloid cysts

Author: Ka-Wai Grace Ho MD

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Editor: Rimas V Lukas MD

Colloid cysts

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Introduction

Overview

Colloid cysts are benign intraventricular lesions commonly located in the third ventricle. Although they may present with a variety of neurologic symptoms, such as headache from obstructive hydrocephalus, they can also be incidentally found during routine radiological evaluation in asymptomatic patients. The clinical presentation, diagnosis, and management of colloid cysts are outlined. Risk stratification for asymptomatic colloid cysts and recently proposed revisions to the classification of anatomic risk zones of colloid cysts are discussed.

Key points

	• Colloid cysts are benign intraventricular lesions that grow slowly but can also cause sudden death from acute obstructive hydrocephalus.
	• Incidentally discovered colloid cysts can be risk stratified for causing obstructive hydrocephalus using the Colloid Cyst Risk Score.
	• Conservative management is a viable treatment option because some colloid cysts can regress spontaneously.
	• Microsurgical resection of colloid cysts, on average, results in a higher percentage of complete resection and decreased recurrence rates compared to endoscopic approaches.
	• Overall morbidity is decreased with endoscopic resection compared to microsurgical resection.

Historical note and terminology

Colloid cysts are benign intraventricular lesions that have a collagenous capsule encompassing a thick gelatinous, viscous material containing mucin, old blood, cholesterol, or ions (30). In 1858, Wallman described the first case of a colloid cyst presenting with urinary incontinence and ataxia (79). Dandy first successfully removed a colloid cyst in 1921 using an approach through the posterior right lateral ventricle (18). Ventriculography at the time was considered the most reliable diagnostic evaluation where cerebral spinal fluid is removed from the ventricles and replaced by air, allowing for better imaging via x-ray (29; 45). An early operative mortality of 20% was discouraging, but subsequent approaches leading up to current microsurgical and endoscopic techniques have reduced operative mortality to near zero (36; 11; 67; 03; 42; 57; 62; 61; 64).

Clinical manifestations

Presentation and course

	• Asymptomatic lesions are often found incidentally on brain imaging for other reasons, the most common of which is trauma.
	• Symptomatic patients commonly present with elevated intracranial pressure symptoms like headache, papilledema, and nausea or vomiting.
	• Colloid cysts can cause neuropsychiatric symptoms like depression, anxiety attacks, paranoid ideation, and memory difficulties.

Patients can present with either asymptomatic or symptomatic colloid cysts. Asymptomatic colloid cysts are often found incidentally on imaging for other reasons, the most common of which is trauma (07). Patients with symptomatic colloid cysts most commonly present with one of three symptom complexes: (1) headache, papilledema, and occasionally false localizing motor and sensory signs; (2) progressive or fluctuating dementia with or without headache and raised intracranial pressure; or (3) paroxysmal severe headaches, nausea, vomiting, stupor, or coma without symptomatology between episodes (36). The first symptom complex is due to constantly elevated intracranial pressure from the cyst compressing the ventricular system, leading to obstructive hydrocephalus. The second symptom complex could be due to direct pressure on structures surrounding the third ventricle, like the medial thalamus, hypothalamus, fornix, corpus callosum, and infundibulum, leading to the mamillary bodies. These areas of the brain are involved in the limbic system, which plays a role in memory and other neuropsychiatric symptom manifestations (43; 60). Depression, anxiety attacks, paranoid ideation, memory difficulties, and decreased cognition are also observed occasionally and are often subtle. Surgical cyst removal, even in the absence of hydrocephalus, has been reported to sometimes ameliorate these symptoms (46). Finally, the transient nature of elevated intracranial pressure symptoms described in symptom complex 3 may be due to the colloid cyst moving in and out of the foramen of Monro on its pedicle with intermittent obstruction of CSF (40).

Individually, headaches are by far the most common symptom (89%), followed by nausea or vomiting (23%), visual decline (22%), dizziness or ataxia (20%), and cognitive decline (14%) (07). Of note, although headaches associated with colloid cysts can have a positional component characteristic of elevated intracranial pressure, they can also resolve or reduce in the supine position (05; 14; 70). Colloid cysts can present with some intraocular findings other than the papilledema traditionally associated with elevated intracranial pressure. For example, one report noted visual field deficits and findings suggestive of glaucoma (55), although another reported intraocular hemorrhage (09).

Untreated patients can develop fatal colloid cysts that may present with acute disturbances of consciousness, coma, and death because of ventricular outflow obstruction with resultant obstructive hydrocephalus (17; 66). Subarachnoid hemorrhage into the colloid cyst can occur, and such patients can manifest with a change in clinical symptoms and an increase in cyst size (51; 23).

Prognosis and complications

Colloid cysts are considered rare benign lesions as they are curable, developmental, and slow-growing malformations; however, they can eventually lead to serious complications, including sudden death from ventricular outflow obstruction (40; 30; 05). The risk of sudden neurologic deterioration or death has been reported at 3% to 35%, with fatal colloid cysts accounting for 0.0015% to 0.009% of all cases of sudden death (40; 68).

Although acute neurologic deterioration has been emphasized, most patients present with long-standing, intractable symptoms that allow for diagnosis and elective surgery. Asymptomatic, incidentally discovered colloid cysts rarely cause acute hydrocephalus or sudden neurologic deterioration in the absence of trauma. Although these lesions can remain the same size for many years, there is a 5% to 15% risk of progression within 5 years of initial diagnosis of an incidental colloid cyst managed nonoperatively (16).

Clinical vignette

The patient was a 36-year-old, right-handed, Caucasian woman who had an abrupt onset of severe headache while bending forward during intense household work. The headache prevented her from activities, and while walking to her bed to lie down, she collapsed to the floor. She was taken to the emergency room for evaluation. On examination, she was found to be stuporous with intact brainstem reflexes. An urgent CT scan of the brain was performed that demonstrated a hyperdense cystic lesion of the third ventricle with obstructive hydrocephalus. The clinical and neuroimaging findings were felt to be compatible with a colloid cyst of the third ventricle. She underwent an emergent ventriculostomy for acute hydrocephalus. Subsequently, she was taken to the operating room for more definitive therapy consisting of endoscopic evacuation of cyst contents and microsurgical resection of the cyst capsule. Thick protenacious material was aspirated from the cyst. Postoperative recovery was gradual but complete, with no discernible neurologic deficits. She was able to return to her usual activities, and a follow-up scan of her brain did not demonstrate any residual lesion or hydrocephalus.

Biological basis

Etiology and pathogenesis

The etiology of colloid cyst is unknown as most cases tend to occur sporadically (13). It is thought that the membrane of the cyst originates from ectopic endodermal elements that migrate into the velum interpositum during the development of the central nervous system. It is then filled postnatally with gelatinous matter (77).

Genetics. Reports of familial colloid cysts in 40 families that involve 83 patients support the growing evidence for the possibility of genetic predisposition in the development of colloid cysts (41; 27; 54). Although there is no consensus on the precise pattern of the genetic predisposition, some authors postulate an autosomal dominant pattern of occurrence (08), although others argue that an autosomal recessive pattern is more plausible (69). Some authors posit that the inheritance is probably multifactorial (71). A large prospective clinical case series analyzed 13 families and their first-degree relatives affected with colloid cysts (26 patients) and reported an estimated familiar colloid cyst rate of 3.4%. The early diagnosis of first-degree relatives with colloid cysts is advised because of the higher risk of symptomatic lesions (61.5% to 89.5%) and mortality (7.7% to 12.3%) compared with those without a family history (27). The first-degree relatives of patients with colloid cysts who develop symptoms suggestive of raised intracranial pressure should be evaluated with MRI screening, and genetic screening is recommended for monozygotic twins (13; 41).

Pathology. Colloid cysts are smooth, spherical masses that arise in the anterior and dorsal regions of the roof of the third ventricle. The wall is a thin membrane enclosing a soft gray proteinaceous material or a dense hyaline substance. The state of the cyst contents varies with the degree of hydration, from thick fluid to a solid gel, and this variation in turn affects the appearance on neuroimaging studies. The wall is composed of fibrous connective tissue lined by benign columnar ciliated epithelial cells (25).

Colloid cyst (pathologic specimen)

The thin capsule, periodic acid-Schiff staining contents, and gliotic envelope are evident. (Contributed by Dr. Sherman Stein.)

Pathophysiology. Although generally regarded as a malformation, the lineage of colloid cysts remains controversial. A neuroectodermal derivation for colloid cysts has been assumed based on structural and embryological considerations as well as their intraventricular location. Potential precursors include choroid plexus, ependyma, primitive neuroectoderm, and the paraphysis. Uncertainty over the specific nature of epithelium lining colloid cysts is reflected in the all-encompassing synonym "neuroepithelial cyst" that is often applied (38). Two immunohistochemical studies using histologic antigens and monoclonal antibodies indicated that colloid cyst epithelium is immunohistochemically different from that of normal or neoplastic choroid plexus. In one, the immunophenotype of colloid cysts was similar to foregut-derived epithelia of enteric and Rathke pouch cysts, supporting endodermal origin for these cysts (39). This observation was further supported by studies on the nature of the cyst contents themselves. These studies indicate that the carbohydrate epitopes exhibited by cysts and their contents are also consistent with an endodermal origin (76).

There are four ventricles (paired lateral, third, and fourth) connected by foramina comprising the ventricular system of the brain that produces CSF, which serves to provide nourishment, waste removal, and protection to the brain (73). The foramen of Monro connects the lateral ventricles to the midline third ventricle, and the aqueduct of Sylvius connects the third ventricle to the fourth ventricle. CSF then flows through the midline foramen of Luschka and the paired foramina of Magendie to reach the subarachnoid space. Most colloid cysts develop just posterior to the foramen of Monro (43). Obstruction anywhere along the intraventricular system can lead to hydrocephalus, which can be fatal.

The most popular hypothesis to explain fatal colloid cysts is the “ball-valve effect” where a colloid cyst moves on its pedicle, which is attached to the ventricular wall and blocks the foramen of Monro, resulting in acute obstructive hydrocephalus. Other theories include cystic apoplexy leading to cyst enlargement and acute obstructive hydrocephalus, mass effect on the hypothalamus leading to the release of catecholamines and subsequent cardiac arrest, head trauma capable of shearing forces that severs the attachment of the cyst to the ventricular wall, and generalized cerebral edema from when a growing colloid cyst raises the pressure in the superior sagittal sinus leading to venous stasis (40).

Diagnostic workup

The diagnosis of colloid cysts can be made definitively with CT or MRI in most cases. On CT scanning, a colloid cyst appears as a distinctive isodense or hyperdense lesion at the foramen of Monro; variable contrast enhancement is noted. Calcifications are not seen within the cyst or in the cyst wall. A distinctive MRI appearance with high signal intensities noted on both T1- and T2-weighted images reflects the high protein content of the viscous cyst material (37; 59). In cases where some of the cyst contents are solid, there is a variable radiographic appearance.

Colloid cyst (CT)

The hyperdense mass protrudes into the foramina of Munro. A shunt tube is seen in the right occipital horn. (Contributed by Dr. Sherman Stein.)
Colloid cyst (MRI) (1)

This coronal, unenhanced, T1-weighted MRI shows a large colloid cyst expanding through the foramina of Munro from the superior third ventricle. There is uniform signal hyperintensity. (Contributed by Dr. Sherman Stein.)
Colloid cyst (MRI) (2)

This midsagittal, unenhanced, T1-weighted MRI shows a small colloid cyst in the superior third ventricle. Signal intensity is increased in the periphery of the cyst and decreased in the center. (Contributed by Dr. Sherman Stein.)

Management

Risk stratification. There is no clear guidance on the management of incidentally diagnosed colloid cysts. Close observation with serial neuroimaging studies may be a safe management strategy. To better risk stratify patients into those who may require surgical intervention given the risk for hydrocephalus versus those who can proceed with close observation, Beaumont and colleagues detailed three anatomic risk zones in the third ventricle on the sagittal plane using vertical lines drawn from the mamillary bodies and tangential to the massa intermedia and a parallel line drawn from the anterior aspect of the aqueduct of Sylvius upwards (07). Zone 1 encompasses the third ventricle anterior to the first line; zone 2 is the area between the first and second line; and zone 3 is posterior to the second line. Zones 1 and 3 were considered risk zones as none of the patients studied with zone 2 lesions presented with obstructive hydrocephalus. This was incorporated into the Colloid Cyst Risk Score (CCRS) used to predict symptomatic clinical status and stratify risk for hydrocephalus in patients presenting with a colloid cyst in the third ventricle. One point is given for age under 65 years, headache, axial diameter of cyst 7mm or larger, fluid-attenuated inversion recovery (FLAIR) hyperintensity, and location in an anatomic risk zone. A CCRS of 4 or higher was significantly associated with obstructive hydrocephalus (p< 0.0001, RR 19.4) (07; 01; 80).

Table 1. Colloid Cyst Risk Score (CCRS)

Criterion	Points
Age <65 years	1
Headache	1
Axial diameter 7mm or larger	1
FLAIR hyperintensity	1
Risk zone (Zone 1 or 3)	1
One point is assigned to each of five categories. A score greater than or equal to 4 suggests a high risk for developing hydrocephalus in patients with a colloid cyst in the third ventricle.

A modified CCRS was developed by Burnhan Janjua and colleagues in 2020 to include factors like gender, additive size gradation based on cyst size, and objective risk quantification of hydrocephalus. The total potential score is 8; patients with a score lower than 4 can be managed conservatively, whereas patients with a score greater than 7 are at risk of symptomatic progression and should be evaluated for surgery (12).

In 2024, Murali and colleagues proposed reclassifying the “anatomic risk zones of colloid cysts” described by Beaumont and associates, with newer landmarks to improve the specificity and positive predictive value for the occurrence of hydrocephalus. Sometimes larger colloid cysts displaced the massa intermedia posteriorly, leading clinicians to classify these cysts as zone 1 cysts and, thus, higher risk when they may not be. Using 122 cases of colloid cysts in the third ventricle diagnosed incidentally or symptomatically, Murali and colleagues suggested drawing the first line from the mamillary body to the coronal suture (MB-Coronal line) to account for this and a second line from the anterior aspect of the aqueduct of Sylvius parallel to the MB-Coronal line. Zone 1 is anterior to the first line, zone 2 in the middle, and zone 3 posterior to the second line. By changing the zoning method, there was a higher specificity (36.2% vs. 5.2%) and positive predictive value (63.3% vs. 54.2%) for the occurrence of hydrocephalus in patients with a colloid cyst when compared to the CCRS (50). Although this adds new insight into risk stratification, this scoring system still needs to be validated.

In summary, modifications are still being made to generate an optimal risk stratification score for colloid cysts. In the interim, however, the Beaumont CCRS remains a relative standard until additional validations are completed for newer scoring systems.

Conservative management. Conservative management of asymptomatic colloid cysts is a viable option. There are six case reports of patients managed with serial neuroimaging who subsequently had spontaneous regression of their lesions in the literature (26; 56; 74; 16; 49; 44). Turel and colleagues suggested that patients with an asymptomatic colloid cyst that is less than 10 mm should have an initial follow-up image 6 to 12 months after diagnosis, and subsequent serial follow-up neuroimaging should be done annually (74).

Surgical management. Present management options for symptomatic colloid cysts include management of hydrocephalus and resection of the intraventricular mass. For patients presenting with symptomatic ventriculomegaly, placement of an emergent external ventricular drain may be required in the acute setting before cyst resection. Hydrocephalus persisting after surgical resection of cysts is typically treated with a ventriculoperitoneal shunt.

Resection of intraventricular colloid cysts is most commonly performed via microsurgical (transcortical-transventricular or interhemispheric-transventricular) or endoscopic approaches with very low mortality rates (0.6% to 1.4%) (19; 53; 15).

Outcomes

There is no consensus on which surgical technique is superior for the treatment of colloid cysts (15; 63; 62). Data suggest that microsurgical approaches afford a higher rate of complete removal and a lower recurrence rate compared to endoscopic treatment (32; 21; 62). In a meta-analysis comparing the outcomes of 1278 patients treated with either approach, those treated with microsurgery had a higher incidence of complete surgical resection (97% vs. 58%) and lower recurrent rate (0.38% vs. 3%) relative to endoscopic treatment (65). Similarly, another meta-analysis reported a higher gross total resection rate (98.15% vs. 91.29%) and lower recurrent rate (0.00% vs. 1.78%) for the microsurgical approach compared to endoscopic surgical treatment (62).

Although the patients treated with the endoscopic approach may not achieve complete resection of the tumor capsule, most of the patients have a low risk of complications, morbidity, mortality, and recurrence in the long term (78; 33). In addition, the endoscopic approach is now assuming a standard front-line surgical option for the treatment of colloid cysts because of the significantly reduced rate of perioperative morbidity and lower cost (63; 06), and it has also decreased the rate of seizures (15% in microsurgery vs. 5% in endoscopic) and readmission rates (65; 15). Furthermore, both the operative time and length of hospital stay are reduced significantly with endoscopic resection (31; 22; 62). Refinements in technical expertise and instrumentation have made the endoscopic technique an efficient surgical option even for large (greater than 20 mm) and giant (greater than 30 mm) colloid cysts (04).

Conversion from endoscopic to microsurgical resection has also been reported (53; 78). One study demonstrated that microsurgical resection of colloid cysts led to a sustained improvement in neurocognitive function, presumably due to the reduction of hydrocephalus or reduction of mass effect on the fornix (60). Morbidity and mortality include intraoperative bleeding, postoperative hydrocephalus, cerebrospinal fluid leak, subdural hematoma, cognitive deficits, seizures, and transient and permanent memory disturbances (67; 34; 72; 52; 20; 02; 14; 35). The amnestic syndrome is caused by bilateral fornix damage; sparing of the left fornix alone is sufficient to ensure a more favorable outcome (47). Clinical and radiological follow-up are necessary to assess and ensures lesion-free survival.

Media

References

01: Alford E, Rotman L, Shank C, Agee B, Markert J. Independent validation of the colloid cyst risk score to predict symptoms and hydrocephalus in patients with colloid cysts of the third ventricle. World Neurosurg 2020;134:e747-53. PMID 31706971
02: Apuzzo ML. Surgery of masses affecting the third ventricular chamber: technique and strategies. Clin Neurosurg 1988;34:499-522.** PMID 3288410
03: Apuzzo ML, Chikovani OK, Gott PS, et al. Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences. Neurosurgery 1982;10(5):547-54. PMID 7099406
04: Arjipour M, Gharib M, Eftekharian M. Endoscopic resection of a giant colloid cyst in the velum interpositum: illustrative case. J Neurosurg Case Lessons 2023;5(1):CASE22381. PMID 36593669
05: Badran S, Al-Juboori A, Khasro M, Alsamok A, Shahadha A. Third ventricular colloid cyst, new surgical classification. World Neurosurg 2024;S1878-8750(24)00554-0. PMID 38599374
06: Beaumont TL, Limbrick DD, Patel B, Chicoine MR, Rich KM, Dacey RG. Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection. J Neurosurg 2022:1-9. PMID 35148502
07: Beaumont TL, Limbrick DD Jr, Rich KM, Wippold FJ 2nd, Dacey RG Jr. Natural history of colloid cysts of the third ventricle. J Neurosurg 2016:125(6):1420-30.** PMID 26967781
08: Benoiton LA, Correia J, Kamat AS, Wickremesekera A. Familial colloid cyst. J Clin Neurosci 2014;21(3):533-5. PMID 24308955
09: Boogaarts H, Grotenhuis A. Terson's syndrome after endoscopic colloid cyst removal: case report and a review of reported complications. Minim Invasive Neurosurg 2008;51(5):303-5. PMID 18855297
10: Bos D, Poels MM, Adams HH, et al. Prevalence, clinical management, and natural course of incidental findings on brain MR images: the population-based Rotterdam Scan Study. Radiology 2016;281(2):507-15. PMID 27337027
11: Bosch DA, Rahn T, Backlund EO. Treatment of colloid cysts of the third ventricle by stereotactic aspiration. Surg Neurol 1978;9:15-8. PMID 341383
12: Burhan Janjua M, Reddy S, El Ahmadieh TY, et al. Inchoate guidelines of endoscopic resection of colloid cysts. J Clin Neurosci 2020;71:1-8. PMID 31839383
13: Calderon C, Fernandez-de Thomas RJ, De Jesus O. Familial colloid cysts of the third ventricle: case report and literature review. Asian J Neurosurg 2020;15(2):414-7. PMID 32656143
14: Camacho A, Abernathy CD, Kelly PJ, Laws ER. Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurgery 1989;24:693-700. PMID 2716977
15: Connolly ID, Johnson E, Lamsam L, Veeravagu A, Ratliff J, Li G. Microsurgical vs. endoscopic excision of colloid cysts: an analysis of complications and costs using a longitudinal administrative. Front Neurol 2017:8:259.** PMID 28649225
16: Cosgrove ME, Saadon J, Chesler DA. Colloid cyst curtailed: a case report of spontaneous colloid cyst regression. Surg Neurol Int 2020;11:465. PMID 33500803
17: Cuoco JA, Rogers CM, Busch CM, Benko MJ, Apfel LS, Elias Z. Postexercise death due to hemorrhagic colloid cyst of third ventricle: case report and literature review. World Neurosurg 2019;123:351-6. PMID 30590211
18: Dandy WE. Benign tumors in the third ventricle of the brain: diagnosis and treatment. Baltimore: Williams & Wilkins, 1933:4-37.
19: Desai KI, Nadkarni TD, Muzumdar DP, Goel AH. Surgical management of colloid cyst of the third ventricle--a study of 105 cases. Surg Neurol 2002;57(5):295-302. PMID 12128295
20: Donauer E, Moringlane JR, Ostertag CB. Colloid cysts of the third ventricle. Open operative approach or stereotactic aspiration. Acta Neurochir 1986;83:24-30. PMID 3541505
21: Elshamy W, Burkard J, Gerges M, et al. Surgical approaches for resection of third ventricle colloid cysts: meta-analysis. Neurosurg Rev 2021;44(6):3029-38. PMID 33590366
22: Farahmand D, Stridh J, Ziegelitz D, Tisell M. Endoscopic versus open microsurgery for colloid cysts of the third ventricle. Br J Neurosurg 2021:1-4. PMID 34034576
23: Fernandez L, Areitio E, López JC, Gómez JJ, Elexpuru JA. Hemorrhagic colloid cyst of the third ventricle: A rare cause of colloid cyst growth and progressive hydrocephalus. Case report. Neurocirugia 2021;32(3):142-7. PMID 32430243
24: Foo CC, Gallo P, Kaliaperumal C. Third ventricular colloid cyst causing acute hydrocephalus during early pregnancy: clinical lessons from a case. Surg Neurol Int 2021;12:54. PMID 33654557
25: Ganti SR, Antunes JL, Louis KM, Hilal SK. Computed tomography in the diagnosis of colloid cysts of the third ventricle. Radiology 1981;138:385-91. PMID 6969901
26: Gbejuade H, Plaha P, Porter D. Spontaneous regression of a third ventricle colloid cyst. Br J Neurosurg 2011;25(5):655-7. PMID 21848442
27: Giantini-Larsen AM, Garton ALA, Villamater FN, et al. Familial colloid cysts: not a chance occurrence. J Neurooncol 2022;157(2):321-32. PMID 35243591
28: Goyal N, Sharma BS, Mahapatra AK. Third ventricular colloid cysts in children - a series of eight cases and review of the literature. Turk Neurosurg 2014;24(1):1-7. PMID 24535783
29: Grant F. Indications for and technic of ventriculography. Radiology 1927;9(5):388-95.
30: Grasso G, Torregrossa F, Gulino V. Risk stratification of hydrocephalus in colloid cysts of the third ventricle. World Neurosurg 2024;184:63-4. PMID 32912876
31: Grondin RT, Hader W, MacRae ME, Hamilton MG. Endoscopic versus microsurgical resection of third ventricle colloid cysts. Can J Neurol Sci 2007;34(2):197-207. PMID 17598598
32: Heller RS, Heilman CB. Colloid cysts: evolution of surgical approach preference and management of recurrent cysts. Oper Neurosurg (Hagerstown) 2020;18(1):19-25. PMID 31220314
33: Isaacs AM, Bezchlibnyk YB, Dronyk, Urbaneja G, Yong H, Hamilton MG. Long-term outcomes of endoscopic third ventricle colloid cyst resection: case series with a proposed graded system. Oper Neurosurg (Hagerstown) 2020:19(2):134-42. PMID 31960056
34: Jeeves MA, Simpson DA, Geffen G. Functional consequences of the transcallosal removal of intraventricular tumours. J Neurol Neurosurg Psychiatry 1979;42:134-42. PMID 422960
35: Jeffree RL, Besser M. colloid cyst of the third ventricle: a clinical review of 39 cases. J Clin Neurosci 2001;8:328-31. PMID 11437572
36: Kelly R. Colloid cysts of the third ventricle. Analysis of 29 cases. Brain 1951;74:23-65. PMID 14830663
37: Khanpara A, Day A, Bhattacharjee M, Riascos R, Fernelius J, Westmark K. The variable appearance of third ventricular colloid cysts: correlation with histopathology and the risk of obstructive ventriculomegaly. Amer J Neurorad 2020;41(10):1833-40. PMID 32912876
38: Kondziolka D, Bilbao JM. An immunohistochemical study of neuroepithelial (colloid) cysts. J Neurosurg 1989;71:91-7. PMID 2472473
39: Lach B, Scheithauer BW, Gregor A, Wick MR. Colloid cyst of the third ventricle. A comparative immunohistochemical study of neuraxis cysts and choroid plexus epithelium. J Neurosurg 1993;78:101-11. PMID 8416224
40: Lagman C, Rai K, Chung LK, et al. Fatal colloid cysts: a systematic review. World Neurosurg 2017:107:409-15.** PMID 28801184
41: Lannon M, Mackenzie J, Reddy K. Genetics of colloid cyst in monozygotic twins: case report and review of literature. World Neurosurg 2020;144:88-91. PMID 32889197
42: Lavyne MH, Patterson RH. Subchoroidal trans-velum interpositum approach to mid-third ventricular tumors. Neurosurgery 1983;12:86-94. PMID 6828226
43: Lawrence JE, Nadarajah R, Treger TD, Agius M. Neuropsychiatric manifestations of colloid cysts: a review of the literature. Psychiatr Danub 2015;27 Suppl 1:S315-20.** PMID 26417787
44: Lee JH, Hong JH, Kim YJ, Moon KS. Spontaneous regression of colloid cyst on the third ventricle: a case report with the review of the literature. BMC Neurol 2022;(1):397. PMID 36309649
45: Little JR, MacCarty CS. Colloid cysts of the third ventricle. J Neurosurg 1974;40(2):230-5. PMID 4543624
46: Lobosky JM, Vangilder JC, Damasio AR. Behavioral manifestations of third ventricular colloid cysts. J Neurol Neurosurg Psychiatry 1984;47:1075-80. PMID 6502164
47: McMackin D, Cockburn J, Anslow P, Gaffan D. Correlation of fornix damage with memory impairment in six cases of colloid cyst removal. Acta Neurochir (Wien) 1995;135:12-8. PMID 8748786
48: Morris Z, Whiteley WN, Longstreth WT Jr, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2009;339:b3016. PMID 19687093
49: Mulcahy MJ, Chaganti J, Al-Khawaja D. The case of the disappearing colloid cyst. World Neurosurg 2020;135:100-2. PMID 31837498
50: Murali S, Parapati V, Kesavapisharady K, Divakar G, Nair P, Venkat E. Colloid cyst: revision of third ventricular zones for risk stratification of hydrocephalus. Word Neurosurg 2024;182:e276-83. PMID 38008168
51: Musa G, Simfukwe K, Gots A, Chmutin G, Chmutin E, Chaurasia B. Clinical and radiological characteristics in fatal third ventricle colloid cyst. Literature review. J Clin Neurosci 2020;82(Pt A):52-5. PMID 33317739
52: Nitta M, Symon L. Colloid cysts of the third ventricle. A review of 36 cases. Acta Neurochir 1985;76:99-104. PMID 3875215
53: Osorio JA, Clark AJ, Safaee M, et al. Intraoperative conversion from endoscopic to open transcortical-transventricular removal of colloid cysts as a salvage procedure. Cureus 2015:7(2):e247. PMID 26180671
54: Otamendi-Lopez A, Marenco-Hillembrand LC, De Biase G, Snyman C, Quiñones-Hinojosa A. Disease characteristics and patterns of familial colloid cyst of the third ventricle: An international survey of the Colloid Cyst Survivors Group. J Clin Neurosci 2022;106:49-54. PMID 36265365
55: Patel DK, Ali NA, Iqbal T, Subrayan V. Colloid cyst of third ventricle mimicking normal tension glaucoma. Ann Ophthalmol (Skokie) 2008 Fall-Winter;40(3-4):177-9. PMID 19230359
56: Peeters SM, Daou B, Jabbour P, Ladoux A, Abi Lahoud G. Spontaneous regression of a third ventricle colloid cyst. World Neurosurg 2016;90:704.e19-704.e22. PMID 26968449
57: Powell MP, Torrens MJ, Thomson JL, Horgan JG. Isodense colloid cysts of the third ventricle: a diagnostic and therapeutic problem resolved by ventriculoscopy. Neurosurgery 1983;13(3):234-7. PMID 6621836
58: Reade MC, Scott DM. Anaesthetic management of a parturient with a colloid cyst of the third ventricle. Anaesth Intensive Care 2000;28(2):211-3. PMID 10788979
59: Roberts A, Jackson A, Bangar S, Moussa M. Colloid cyst of the third ventricle. J Am Coll Emerg Physicians Open 2021;2(4):e12503. PMID 34409403
60: Roth J, Sela G, Andelman F, Nossek E, Elran H, Ram Z. The impact of colloid cyst treatment on neurocognition. World Neurosurg 2019. PMID 30703590
61: Saleem A, Najibullah M, Shabbir Z, Azab W. Endoscopic trans-septal interforniceal approach for excision of colloid cysts of the third ventricle using the rotational technique. Childs Nerv Syst 2023. [Epub ahead of print] PMID 37173435
62: Sayehmiri F, Starke RM, Eichberg DG, et al. Comparison of microscopic and endoscopic resection of third-ventricular colloid cysts: a systematic review and meta-analysis. Clin Neurol Neurosurg 2022;215:107179. PMID 35220036
63: Sethi AB, Cavalcante D, Ormond R. Endoscopic versus microscopic transcallosal excision of colloid cysts: a systematic review in the era of complete endoscopic excision. World Neurosug 2019;132:e53-8. PMID 31518748
64: Sharifi G, Mohammadi E, Jafari A, et al. Endoscopic versus microsurgery resection of third ventricle colloid cysts: a single-center case-series of 140 consecutive patients. World Neurosurg 2023:S1878-8750(23)00558-2. PMID 37116788
65: Sheikh AB, Mendelson ZS, Liu JK. Endoscopic versus microsurgical resection of colloid cysts: a systematic review and meta-analysis of 1,278 patients. World Neurosug 2014:82(6):1187-97. PMID 24952223
66: Shoyab M. Brainstem death due to intracranial hypertension with hydrocephalus, produced by a third ventricular colloid cyst. BJR Case Rep 2022;8(4):20220007. PMID 36451909
67: Shucart WA, Stein BM. Transcallosal approach to the anterior ventricular system. Neurosurgery 1978;3:339-43. PMID 740132
68: Singh H, Janjua M, Ahmed M, et al. Factors influencing outcome in patients with colloid cysts who present with acute neurological deterioration. J Clin Neurosci 2018; 54:88-95. PMID 29907387
69: Socin HV, Born J, Wallemacq C, Betea D, Legros JJ, Beckers A. Familial colloid cyst of the third ventricle: neuroendocrinological follow-up and review of the literature. Clin Neurol Neurosurg 2002:104(4):367-70. PMID 12140107
70: Spears RC. Colloid cyst headache. Curr Pain Headache Rep 2004;8(4):297-300. PMID 15228889
71: Stoodley MA, Nguyen TP, Robbins P. Familial fatal and near fatal third ventricle colloid cysts. Aust N Z J Surg 1999;69:733-6. PMID 10527352
72: Sussman NM, Gur RC, Gur RE, et al. Mutism as a consequence of callosotomy. J Neurosurg 1983;59:514-9. PMID 6886765
73: Telano LN, Baker S. Physiology, cerebral spinal fluid. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID 30085549
74: Turel MK, Kucharczyk W, Gentili F. Spontaneous resolution of colloid cyst of the third ventricle: Implications for management. Asian J Neurosurg 2017;12(2):203-6. PMID 28484531
75: Vazhayil V, Sadashiva N, Nayak N, Prabhuraj AR, Shukla D, Somanna S. Surgical management of colloid cysts in children: experience at a tertiary care center. Childs Nerv Syst 2018;34(6):1215-20. PMID 29488075
76: Veerman EC, Go KG, Molenaar WM, et al. On the chemical characterization of colloid cyst contents. Acta Neurochir 1998;140:303-6. PMID 9689320
77: Velicu MA, Rossmann K, Vahedi A, et al. On natural history and management of colloid cysts: time to rethink? World Neurosurg 2023;170:e188-99. PMID 36323347
78: Vorbau C, Baldauf J, Oertel J, Gaab MR, Schroeder HWS. Long-Term Results After Endoscopic Resection of Colloid Cysts. World Neurosurg. 2019;122:e176-e185. PMID: 30292657
79: Wallman H. Eine colloid cyste im dritten Hirnventrikel und ein lipom in plexus choroides. Virchows Arch Pathol Anat 1858;14:385-8.
80: Zeineddine HA, Westmark K, Khanpara S, et al. Risk analysis and management of third ventricular colloid cysts. World Neurosurg 2021;146:e1071-8. PMID 33246179

Contributors

All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.

Author

Ka-Wai Grace Ho MD

Dr. Ho of Harvard Medical School has no relevant financial relationships to disclose.
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Editor

Rimas V Lukas MD

Dr. Lukas of Northwestern University Feinberg School of Medicine received honorariums from Novartis and Novocure for speaking engagements, honorariums from Cardinal Health, Novocure, and Merck for advisory board membership, and research support from BMS as principal investigator.
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Former Authors

Lawrence D Recht MD
Zubair A Shaikh MD
Matthew C Tate MD PhD
Adefisayo Adekanmbi MBBS MSc FWACS
Abiodun Idowu Okunlola MD MSc FWACS

Patient Profile

Age range of presentation: Typical: 19 to 64 years

Atypical: <18 years
Sex preponderance: No sex preponderance
Heredity: No hereditary factors
Population groups selectively affected: No population group selectively affected.
Occupation groups selectively affected: No occupation group selectively affected.

ICD & OMIM codes

ICD-10: Colloid cysts: Q04.8
ICD-11: Colloid cysts: LA05.7
OMIM: Colloid cysts of the third ventricle: 609363

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Colloid cysts

Associated Disorders

Neoplasia: neurobehavioral aspects
Neuroepithelial cysts

Differential Diagnosis

Any third ventricular mass
Choroid plexus papillomas
Glial tumors
Metastases
Craniopharyngioma
- Granuloma
- Hematomas
- Basilar artery aneurysms
- Suprasellar pituitary adenomas
- Metastatic lesion to choroids plexus

Colloid cysts

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Confusing conditions

Associated or underlying disorders

Diagnostic workup

Management

Table 1. Colloid Cyst Risk Score (CCRS)

Outcomes

Special considerations

Pregnancy

Anesthesia

Media

References

Contributors

Author

Editor

Former Authors

Patient Profile

ICD & OMIM codes

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