It's Not Rocket Science
R. Annie Gough in Injury Illustrated, 2020
It is key to slow down, take the time, focus. That goes for illustrators, lawyers, and surgeons. I received a medical malpractice case, an errant brain surgery. The client had years of radiology studies on her condition. Initially overwhelmed by the timeline of brain scans, I was intrigued as soon as I read the operation report. The client's name was Stephanie, and she had positional headaches. This means she suffered severe headaches when she held her head in a specific way. If leaning back caused the pain, she would get relief by leaning forward. This headache was caused by changes in cerebrospinal fluid (CSF) flow. Stephanie had a cyst interrupting the passage of CSF fluid in her brain. As described by the medical record, it was a colloid cyst in the third ventricle. This was not a tumor or a malignancy of any kind. It was a benign collection of epidermal cells. It hung down from the choroid plexus in the midline, softly touching the bilateral thalami. There are two lobes, a right and left thalamus, plural thalami. The CSF moving from the lateral ventricles to the fourth ventricle had to pass through the third ventricle, meaning it had to pass by this cyst. The cyst would clog the flow. Stephanie's doctors decided she should have surgery to remove the cyst. However, the surgeon instead removed a long section of normal brain tissue, a path through her right thalamus into her left cerebellar peduncle.
Disorders of Circulation of the Cerebrospinal Fluid
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Although recurrence of the colloid cyst rarely occurs, most patients do well after complete resection. Patients treated with shunting may have fewer immediate complications, and this may be an appropriate treatment strategy for older patients or patients with shorter life expectancies. However, the treatment of the patient's colloid cyst with ventriculoperitoneal shunting rather than resection incurs the high lifetime shunt complication rate, including shunt failure, shunt infection, overdrainage, subdural hematoma, or subdural hygroma. Some nonobstructing colloid patients have been observed, but this is rarely done.
Key terms
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad in Neurosurgery, 2014
Colloid cyst – a benign, epithelium-lined cyst believed to originate from the anterior part of the third ventricle. The cysts are believed to derive from either primitive neuroepithelium of the tela choroidea or from the endoderm. Because of its location, it can cause obstructive hydrocephalus and increased intracranial pressure.
First reported case of hydrocephalus in jointly diagnosed bacterial meningitis and a colloid cyst: how Ockham’s razor became Hickam’s dictum
Published in British Journal of Neurosurgery, 2022
Gareth May, Simon Lammy, Aditaya Kumar, Ajay Hegde, Edward Jerome St. George
A colloid cyst is a benign intracranial lesion which accounts for 0.5 − 3.0% of primary brain neoplasms.1 Most are asymptomatic and arise in the anterior aspect of the third ventricle. Its proximity to the interventricular foramen of Munro can cause obstructive hydrocephalus which may result in coma and death if left untreated.2 Although symptomatic colloid cysts often present due to symptoms of raised intracranial pressure (ICP),3 rare cases of aseptic meningitis have been reported secondary to extravasation of cyst contents.4 Our case highlights how the quest for diagnostic parsimony resulted in our patient being diagnosed with a symptomatic colloid cyst (Ockham’s razor).5 However, subsequent blood and cerebrospinal fluid (CSF) cultures grew Streptococcus pneumoniae. The ensuing diagnostic uncertainty to the actual cause of his hydrocephalus reflects the importance of Hickam’s dictum,6 “a man can have as many diseases as he damn well pleases.” And in our post-modern society any human being can have as many diseases as they damn well please.
Endoscopic versus open microsurgery for colloid cysts of the third ventricle
Published in British Journal of Neurosurgery, 2023
Dan Farahmand, Johannes Stridh, Doerthe Ziegelitz, Magnus Tisell
The diagnosis of colloid cyst was confirmed by pathology in 44 (86%) patients. In the cases where the histopathological report was missing (5 in the OS group and 2 in the ES group), the diagnosis was based on the combination of radiographic and intraoperative findings.
Related Knowledge Centers
- Amnesia
- Brain Herniation
- Diplopia
- Intracranial Pressure
- Third Ventricle
- Neoplasm
- Headache
- Vertigo
- Hydrocephalus
- Interventricular Foramina