الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Colloid cysts are benign congenital tumors that almost always arise in adult from the anterior third ventricle. It can cause serious morbidity and acute obstructive hydrocephalus that may lead to occasional mortality. It represents 0.5-1% of all primary brain tumors and 15-20% of all intra ventricular masses.
It generates tremendous interest for the neurosurgeon because of its benign nature, deep location , an excellent prognosis when diagnose early and excised and serious outcome up to sudden death if left undiagnosed . However the treatment of this benign tumor remains controversial and the best surgical option has not been established. Microsurgical resection, shunt insertion, stereotactic aspiration and endoscopic resection.
Diagnosis could be made only by non contrast CT scan but MRI have important rules , MRI differentiates colloid cyst from solid mass although according to signal in MRI (especially T2) we could predict lesion consistency and suckability and differentiate colloid cysts from basilar tip aneurysms.
This study was done prospectively in the Neurosurgery Department, Alexandria Main University Hospital, Alexandria University affiliated hospitals. The cases were admitted in the period between May 2016 and December 2017 on 20 patients undergoing endoscopic colloid cyst resection ,all patient included in this study have hydrocephalus , fresh and symptomatic .
We don’t operate asymptomatic cases with small lesion without hydrocephalus.
The aim of the work in this study to define the possibility of safe removal of colloid cysts using the endoscope as well as to assess the potential risks associated with the procedure.
The Gaab rigid scope system was used throughout our series Rigid 0-degree endoscopes (with an 6.5 mm outer diameter) was used. Single ports were used for all patients.
Under general anesthesia patient position 300 flexed , Kocher burr hole was used. The track created by the Cushing ventricular needle was followed by the endoscopic tracker and sheath. The tracker was removed and the rigid lens scope was introduced. Navigation inside the lateral ventricle was done for identification of the anatomical landmarks and the colloid cyst at the foramen of Monro. Choroid plexus is followed anteriorly till foramen of Monro is reached. Evacuation of the cyst content was carried out by intermittent controlled suction through 6F Neleton catheter introduced inside the cyst cavity.
After complete evacuation of the colloid material, the whole cyst capsule was gathered using the suction tube, grasped and then pealed gently with the aid of an endoscopic grasper. Bleeding was controlled then Removal of the endoscope carefully, Routinely External ventricular drain was used and kept closed and opened only in emergency All cases were admitted to the intensive care unit and early post operative CT brain was done . In the current study we had zero mortality and little morbidity.
Most common complication is bleeding it was successfully controlled by usual technique of irrigation and compression by balloon in all cases except one cases .microscope was introduced to remove tumors residual and control the bleeding. Post operative complication was hydrocephalus and was happed in one case and treated by permanent VP shunt, memory problem that resolved within the follow period. with the post operative follow up imaging only 3 cases have small residual only one needed another microscopic surgery after 6 month.
The endoscopic treatment of colloid cysts is becoming widespread in neurosurgical practice because it is a reliable technique that offers many advantages (reduced surgery time, shorter hospital stay and also reduction in morbidity and mortality compared to microsurgery). In this study, it is an up-to-date approach, and preliminary results are encouraging, thus, it is a promising technique for the treatment of colloid cysts and intra ventricular tumor. However, continous training is necessary and remains an important factor in improving the quality of the endoscopic removal of cysts.