Endoscopic Colloid Cyst Resection

This is a 54-year old man who was diagnosed
with a pituitary macroadenoma causing pituitary dysfunction as well as a colloid cyst causing
obstructive hydrocephalus. It was clear that the macroadenoma needed
to be resected. However, the patient was asymptomatic from
his colloid system hydrocephalus. And, he is a high functioning engineer. There was concern though that if a cerebral
spinal fluid leak occurred during the surgery of the adenoma, there would be a higher chance
of failure of the repair if there was existing hydrocephalus. Therefore, the patient was recommended to
undergo resection of the colloid cyst first. Followed by the adenoma resection. This was performed with an endoscopic approach
through the lateral ventricle with a coaxial endoscope. We see here, initially, the anatomy which
involves the choroid plexus, which is now being cauterized as well as the septal vein
and the thalamostriate vein and the fornix, which is on the right of the image. An aspirator with a cutting device called
the myriad is utilized to resect, initially the choroid plexus, which was cauterized. Followed by the capsule wall. This is a great device to work through a single
channel given its aspiration and cautery techniques without using
to the third ventricle. The capsule of the cyst is cut sharply with
scissors. And, the content is removed with the aspirator. This particular cyst had content that was
both liquid and solid. The liquid gelatinous content was easy to
be removed with the aspirator. Whereas, the solid content required further
manipulation of the tissue to be able to remove it. Also, to ensure that there is a very low chance
of cyst recurrence, we attempt to resect the entire capsule as safely as possible. A small amount of capsule is typically left
behind along the roof of the third ventricle to prevent any significant neurological injury. The majority of the capsule is resected with
the aspirator device, called the Nico myriad, which allows a cutting device with suction. Which, is ideal and a coaxial approach. As you can see here. Then the capsule is removed in a piecemeal
fashion. And, allows us to get the contents of the
capsule out without as much difficulty as before. You can see the capsule contents there are
quite firm and solid and we utilize graspers to remove this. The consistency of this content is much like
sandstone. And, it would crumble when manipulated. Once we were able to fully remove that content,
we then continued to take down the capsule as best as possible. And, left a small amount of capsule at the
rim of the roof of the ventricle. Once we’re able to fully expose this area,
we can see clearly the contents of the floor of the third ventricle. Including, at times, the mammillary bodies
and the tuber cinereum. As well as the optic protuberance, which is
not visible at this point. A third ventriculostomy was not performed
as the primary mode of obstruction was just through to the college cyst. This maneuver has allowed us to completely
remove the cyst contents. And, the majority of the cyst capsule. Decreasing the risk of recurrence of the cyst
down the line. And, here’s the view of the foramen monro,
with a septal vein and thalamostriate vein intact. And, the fornix anterior to us. Postoperative films demonstrate a good resection
of the colloid cyst. Whereas, the ventricles will take time to
decrease. The patient did well after surgery and also
had a successful pituitary adenoma resection.

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