Trans-sulcal, Channel-Based Parafascicular Surgery for Colloid Cysts

Abstract

Colloid cysts are rare, slow-growing benign tumors that represent <1% of all intracranial neoplasms (Beaumont et al, J Neurosurg 125(6):1420–1430, 2016). These tumors classically occur within the third ventricle and can cause obstructive hydrocephalus by blocking the foramina of Monro. Surgery for these lesions is indicated for patients who present symptoms of increased intracranial pressure or have neurologic progression upon follow-up imaging. Open microsurgical approaches for these lesions can be associated with significant morbidity and mortality because accessing, resecting, and achieving hemostasis can be especially challenging in the ventricles, which are deep-seated, associated with critical neurovascular structures, and consist of fluid-filled cavities. The traditional techniques for accessing these lesions historically involved large craniotomies, extensive white matter dissections, prolonged retraction of the brain with bladed retractors, and potential for tissue injury throughout the surgery. The use of channel-based retractors including peel-away catheters, ovular-shaped retractors, and circular sheaths has provided minimally invasive techniques for accessing the ventricles through the brain. They facilitate surgical access to these lesions by minimizing cortical damage with trans-sulcal approaches, displacing the white matter with circumferential retraction, and providing a protected corridor for access and resection. In this chapter, we discuss the use of trans-sulcal, parafascicular approaches for the resection of colloid cysts using channel-based retractors.