Fully endoscopic transfrontal removal of third ventricular colloid cysts: Early experiences and surgical insights from a beginner neuroendoscopic surgeon team

Title : Fully endoscopic transfrontal removal of third ventricular colloid cysts: Early experiences and surgical insights from a beginner neuroendoscopic surgeon team

Abstract:

Background: Colloid cysts (CCs) of the third ventricle are rare benign lesions that may present with obstructive hydrocephalus and sudden neurological deterioration. With advancements in minimally invasive neurosurgery, endoscopic resection has emerged as a viable alternative to microsurgical techniques. This study presents the initial experience of a beginner neurosurgical team using a fully endoscopic transfrontal approach for colloid cyst removal.

Methods: Between July 2023 and March 2025, ten patients (mean age 40.9 years; 6 females, 4 males) underwent fully endoscopic transfrontal resection of third ventricular colloid cysts at the National Institute of Neurosciences & Hospital, Dhaka, Bangladesh. Clinical presentation, surgical technique, intraoperative challenges, postoperative outcomes, and complications were analyzed.

Results: Headache was the most common presenting symptom. The mean cyst diameter was 16.9 mm. seven patients had hydrocephalus at presentation; two required postoperative VP shunt insertion. Total resection was achieved in eight cases (80%), while two underwent subtotal resection (20%). One patient experienced postoperative memory impairment, one developed meningitis, and one mortality (10%) occurred. The approach yielded favorable symptomatic relief, especially in cases with complete resection, with low recurrence rates.

Conclusion: Fully endoscopic removal of third ventricular colloid cysts is a safe and effective technique for appropriately selected patients, even in the early phase of endoscopic neurosurgical practice. Key surgical insights include the importance of strategic trajectory planning via Kocher’s point, continuous irrigation for a clear operative field, gentle dissection near critical structures, and the helpful role of endoscope-holding systems during early learning. Dedicated teamwork, structured training, and gradual experience accumulation are essential for achieving optimal outcomes.

Biography:

Mesbah Uddin Ahmed studied medicine in Sylhet M A G Osmani Medical College in Bangladesh and graduated as MBBS on 2009. He joined in his neurosurgical fellowship program in 2013 and completed his FCPS in Neurosurgery in 2023 from Bangladesh College of Physicians and Surgeons. He has been working in National Institute of Neurosciences & Hospital at Dhaka, Bangladesh since 2019. He is one of the few neurosurgeons in Bangladesh working focused on endoscopic cranial approaches and keyhole brain surgery.