eMedicine Specialties > Neurosurgery > Neoplasm

Colloid Cysts: Workup

Author: Lawrence S Chin, MD, FACS, Professor and Chairman, Department of Neurosurgery, Boston University School of Medicine; Neurosurgeon-in Chief, Boston Medical Center
Coauthor(s): Mayur Jayarao, MD, Fellow, Department of Neurosurgery, Boston Medical Center
Contributor Information and Disclosures

Updated: Jan 7, 2008

Workup

Laboratory Studies

Routine preoperative studies, including a CBC count, chemistry panel, and coagulation studies are performed in addition to various imaging modalities.

Imaging Studies

CT scan
Colloid cysts appear homogenous, with two thirds of them appearing hyperdense to the surrounding parenchyma and one third appearing isodense to the surrounding parenchyma. The lesions are well delineated and are usually round or ovoid. Occasionally, the lesions have a thin rim of enhancement after contrast injection, but they are typically nonenhancing and are not calcified. The size of these cysts varies, but most are 5-25 mm.
 
The CT scan is an important preoperative study because the viscosity of the cyst contents correlates more closely to the radiodensity visible on a CT scan than to the density visible on MRI. The viscosity of cyst contents determines the most appropriate surgical approach. A hyperdense cyst is more likely to have solid contents and is more difficult to drain. Hyperdensity may also correlate with a reduced capacity to enlarge over time. 

MRI

The appearances of colloid cysts on MRIs are variable. The most common appearance is hyperintensity on T1 and hypointensity on T2. The amount of rim enhancement is variable. The variable MRI signals do not correlate with the fluid density of cyst contents, although a MRI is valuable in differentiating a colloid cyst from a basilar tip aneurysm, which may a have similar appearance on a CT scan.

Additionally, recognizing that a CSF flow artifact at the Monro foramen can mimic the appearance of a colloid cyst through MRI is important. Finally, the Constructive Interference in the Steady State (CISS) sequence of a MRI can delineate an abnormal contour of the ventricular system and intraventricular septa, from which essential information for surgical planning, including endoscopic surgery can be obtained. Postoperative CISS images can also be used, demonstrating not only regression of hydrocephalus but also the patency of small fenestrations.

In a retrospective study of 19 patients who underwent endoscopic management of colloid cysts of the third ventricle, El-Khoury et al found that 100% of lesions with low signal intensity on T2 weighted images had a higher intracystic viscosity contents that translated to an increased difficulty in aspiration of the contents.3 In contrast, 63% of patients with high-signal lesions were easy to aspirate. This differentiation may be useful in preoperative planning and management.

Other Tests

Ophthalmologic evaluation may be useful if diplopia (seen in 10% of patients) is a presenting complaint or if papilledema (seen in 50% of patients) is found during the examination. Neuropsychological evaluation may be useful if memory loss or behavior change (found in 35-40% of patients) is a presentation.

Diagnostic Procedures

Lumbar puncture
Lumbar puncture is absolutely contraindicated in patients with these lesions because of a risk of cerebral herniation.

Histologic Findings

Colloid cysts are lined with simple or pseudostratified epithelial cells. Their shape is either flattened cuboidal or low columnar, and they rest on a thin capsule of collagen and fibroblasts. The cysts are mucin secreting and ciliated. Cells are Periodic Acid-Schiff (PAS) and S100 positive, while Glial Fibrillary Acidic Protein (GFAP), vimentin, and neurofilament are negative. The stromal wall stains positively for vimentin. Contents of the cyst are usually greenish and of variable viscosity.

More on Colloid Cysts

Overview: Colloid Cysts
Workup: Colloid Cysts
Treatment: Colloid Cysts
Follow-up: Colloid Cysts
Multimedia: Colloid Cysts
References
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References

  1. Stoodley MA, Nguyen TP, Robbins P. Familial fatal and near-fatal third ventricle colloid cysts. Aust N Z J Surg. Oct 1999;69(10):733-6. [Medline].

  2. Pollock BE, Schreiner SA, Huston J. A theory on the natural history of colloid cysts of the third ventricle. Neurosurgery. May 2000;46(5):1077-81; discussion 1081-3. [Medline].

  3. Camacho A, Abernathey CD, Kelly PJ, Laws ER. Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurgery. May 1989;24(5):693-700. [Medline].

  4. Tanei T, Fukui K, Kato T, Wakabayashi K, Inoue N, Watanabe M. Colloid (enterogenous) cyst in the frontal lobe. Neurol Med Chir (Tokyo). Aug 2006;46(8):401-4. [Medline].

  5. Abdou MS, Cohen AR. Endoscopic treatment of colloid cysts of the third ventricle. Technical note and review of the literature. J Neurosurg. Dec 1998;89(6):1062-8. [Medline].

  6. Akins PT, Roberts R, Coxe WS, Kaufman BA. Familial colloid cyst of the third ventricle: case report and review of associated conditions. Neurosurgery. Feb 1996;38(2):392-5. [Medline].

  7. Bavil MS, Vahedi P. Familial colloid cyst of the third ventricle in non-twin sisters: Case report, review of the literature, controversies, and screening strategies. Clin Neurol Neurosurg. Jun 8 2007;[Medline].

  8. Beems T, Menovsky T, Lammens M. Hemorrhagic colloid cyst: case report and review of the literature. Surg Neurol. Jan 2006;65(1):84-6. [Medline].

  9. Buttner A, Winkler PA, Eisenmenger W, Weis S. Colloid cysts of the third ventricle with fatal outcome: a report of two cases and review of the literature. Int J Legal Med. 1997;110(5):260-6. [Medline].

  10. El Khoury C, Brugières P, Decq P, Cosson-Stanescu R, Combes C, Ricolfi F. Colloid cysts of the third ventricle: are MR imaging patterns predictive of difficulty with percutaneous treatment?. AJNR Am J Neuroradiol. Mar 2000;21(3):489-92. [Medline].

  11. Harris AE, Hadjipanayis CG, Lunsford LD, et al. Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery. Jan 2005;56(1 Suppl):125-32; discussion 125-32. [Medline].

  12. Inci S, Al-Rousan N, Söylemezoglu F, Gurçay O. Intrapontomesencephalic colloid cyst: an unusual location. Case report. J Neurosurg. Jan 2001;94(1):118-21. [Medline].

  13. Jarquin-Valdivia AA, Rich AT, Yarbrough JL, Thompson RC. Intraventricular colloid cyst, hydrocephalus and neurogenic stunned myocardium. Clin Neurol Neurosurg. Aug 2005;107(5):361-5. [Medline].

  14. Kumar S, Singh AK, Sachdev M. Colloid cyst of third ventricle--a study of 11 cases. J Indian Med Assoc. Nov 1998;96(11):351, 353. [Medline].

  15. Kurihara N, Takahashi S, Tamura H, Higano S, Furuta S, Jokura H. Investigation of hydrocephalus with three-dimensional constructive interference in steady state MRI. Neuroradiology. Sep 2000;42(9):634-8. [Medline].

  16. Mathiesen T, Grane P, Lindgren L, Lindquist C. Third ventricle colloid cysts: a consecutive 12-year series. J Neurosurg. Jan 1997;86(1):5-12. [Medline].

  17. Müller A, Büttner A, Weis S. Rare occurrence of intracerebellar colloid cyst. Case report. J Neurosurg. Jul 1999;91(1):128-31. [Medline].

  18. Pollock BE, Huston J. Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg. Sep 1999;91(3):364-9. [Medline].

  19. Poreh A, Winocur G, Moscovitch M, Backon M, Goshen E, Ram Z. Anterograde and retrograde amnesia in a person with bilateral fornix lesions following removal of a colloid cyst. Neuropsychologia. 2006;44(12):2241-8. [Medline].

  20. Rodziewicz GS, Smith MV, Hodge CJ Jr. Endoscopic colloid cyst surgery. Neurosurgery. Mar 2000;46(3):655-60; discussion 660-2. [Medline].

  21. Timurkaynak E, Izci Y, Acar F. Transcavum septum pellucidum interforniceal approach for the colloid cyst of the third ventricle Operative nuance. Surg Neurol. Nov 2006;66(5):544-7; discussion 547. [Medline].

  22. Urso JA, Ross GJ, Parker RK, Patrizi JD, Stewart B. Colloid cyst of the third ventricle: radiologic-pathologic correlation. J Comput Assist Tomogr. Jul-Aug 1998;22(4):524-7. [Medline].

  23. Young WB, Silberstein SD. Paroxysmal headache caused by colloid cyst of the third ventricle: case report and review of the literature. Headache. Jan 1997;37(1):15-20. [Medline].

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Further Reading

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Keywords

colloid cysts, neuroepithelial cyst, paraphyseal cyst, obstructive hydrocephalus, primary brain tumors, intraventricular masses, increased intracranial pressure, hydrocephalus, anterior third ventricle, increased intracranial pressure

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Contributor Information and Disclosures

Author

Lawrence S Chin, MD, FACS, Professor and Chairman, Department of Neurosurgery, Boston University School of Medicine; Neurosurgeon-in Chief, Boston Medical Center
Lawrence S Chin, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Association for the Advancement of Science, American Association of Neurological Surgeons, American College of Surgeons, Children's Oncology Group, Congress of Neurological Surgeons, Phi Beta Kappa, and Society for Neuro-Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Mayur Jayarao, MD, Fellow, Department of Neurosurgery, Boston Medical Center
Mayur Jayarao, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and Medical Council of India
Disclosure: Nothing to disclose.

Medical Editor

Scott C Dulebohn, MD, Assistant Professor, Department of Surgery, Division of Neurosurgery, University of Minnesota College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Disclosure: Nothing to disclose.

CME Editor

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

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