Colloid Cyst and Surgery

[telford]

During a CT scan following a vehicle accident, my wife was found to have soft tissue density overlying the 3rd ventricle near the Foramen of Munro, with no dilation of the lateral ventricles, unrelated to the accident. A stealth MRI was performed with and without contrast, which showed a hyperintense colloid cyst within the ventral aspect of the 3rd ventricle. It measured 9mm anteroposteriorly by 14mm in height by 8mm and does not enhance.
  Currently there is no evidence of hydrocephalus or white matter disease. She is asymptomatic ( no headaches, no gait disturbances, no mental impairment).The neurosurgeon that evaluated the reports advised immediate removal of any cyst larger than 10mm, regardless of the absence of symptoms
  We'd like a second opinion on the advisability/necessity of surgical removal of the cyst at this time, as opposed to monitoring via furthur MRI scans.
  Thank You

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. Colloid cysts are benign tumors that frequently arise from the roof of the third ventricle (a ventricle is the hollow area inside the brain).  These tumors can be asymptomatic or can cause a variety of symptoms with headaches and confusion/memory loss being the most common.  These tumors sit in an area that the spinal fluid flows through (near the foramen of Monro) and can cause blockage at this point, which leads to hyrdrocephalus (a buildup of spinal fluid pressure in the brain.  In rare cases, sudden death has been linked to rapid expansion of a colloid cyst due to severe hydrocephalus, these people generally have some symptoms prior to the event (for example 3 months of headache) but the cyst may go undiagnosed if imaging is not done.  The factor that has been associated with a risk of hydrocephalus and rapid decline is the size of the tumor (>10mm).  There have also been studies that have examined the natural history of colloid cysts, which have concluded that serial imaging with MRI in an asymptomatic persons is safe.  Thus this area is controversial.  The good news is that surgical outcome from removal of the colloid cysts seem to be very good.  The decision that you have to make is to weight the risk of possible complications from the cysts against the risk of the surgery.  If your wife is truly asymptomatic then serial MRI imaging may be reasonable at this point.  I would make sure they are relatively frequent at first, 3-6 months, then they can be spaced out if there is no change in growth or symptoms.  Also make sure a CINE spinal fluid flow study is done with each one.  You will need to find a neurosurgeon who is willing to follow the serial imaging, if that is the path you choose.  You should keep a close watch for headaches, confusion/memory problems, visual problems, and/or urinary incontinence.  If any of the symptoms occur you should seek immediate attention.  Keep in mind that if you do require surgery the outcome are generally good.
I hope this has been helpful.

[lyndanj]

My now 25 yr. old son had a colloid cyst (25 mm)removed 3 years ago, but a small amount of the membrane was left behind as it was attached to a blood vessel. Based on 2 MRIs 6 months apart, he has been told that it has recurred. He will have another MRI in 3 months.  His was also discovered after an auto accident and cat scan and he has been asymptomatic,though there was some evidence of hydrocephalus presurgery. Is there any way to remove the entire cyst?  I would think that blood vessels can be surgically dealt with without causing hemorrhage.  And is there any danger from repeated MRI scans?

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