Twenty colloid cysts - Comparison of endoscopic and microsurgical management

The management of colloid cyst remains controversial, evaluation of the com peting methods seems to be necessary. We report on our experience with coll oid cysts in the last decade: ten were managed solely endoscopically, 10 we re resected microsurgically (9 via a transcortical/transventricular, 1 via a transcallosal approach). The outcome in the endoscopic group was excellen t in 9 cases and unsatisfying in 1 case (recurrence). In the microsurgical group we achieved a good outcome in 5 of 10 cases, a fair outcome in 4 case s and 1 lethal outcome (caused by pulmonary embolism). Complications in the endoscopic group: one intraoperative bleeding, 1 stitch granuloma, 1 mispu ncture of the ventricle, and 1 meningitis. Complications in the microsurgic al group: 1 subdural effusion, 1 flap infection, 1 mild hemiparesis, 1 tran sient impairment of consciousness and 1 pulmonary embolism. Mean operative time and length of hospitalization of the endoscopic group were clearly sho rter than in the microsurgical group: 91 min versus 267 min time of surgery , 5.1 days versus 18.9 days of hospitalization. Complete resection was achi eved in 8 of 10 cases of microsurgery, and in 3 of 10 cases in endoscopy. E ndoscopic management results in lower costs and superior patients' comfort. The reduced number of total resections in the endoscopic group may lead to a higher recurrence rate in long-term follow-up, which might be a serious disadvantage of endoscopy. However, more experience in the endoscopic techn iques may result in a higher rate of total resection of colloid cysts.