Objective: To examine recurrence rates in patients undergoing microsurgical excision of colloid cysts of the third ventricle with long-term serial clinical and imaging follow-up and to identify risk factors for cyst recurrence.
Methods: In this retrospective study, we analyzed a single-surgeon cohort of 84 patients who underwent microsurgical excision of a third ventricular colloid cyst between 1994 and 2018 and who were followed for at least 12 months after surgery. The primary outcome of interest was recurrence (asymptomatic and symptomatic).
Results: The mean age at surgery was 33.8 years (range, 8-65 years). Of 84 patients, 82 (97.6%) were symptomatic and 71 (84.5%) had obstructive hydrocephalus. The mean tumor size was 15.2 mm (range, 7-35 mm). A total or near-total excision was achieved in 76 patients (90.5%). The median clinical follow-up duration was 89.5 months (range, 12-340 months). A total of 81 (96.4%) had follow-up imaging. Overall, recurrence occurred in 25 cases (29.8%), with 7 (8.3%) experiencing symptomatic recurrence. No specific risk factors for recurrence were identified. Longer follow-up was associated with a higher detection of recurrences. The 5-year recurrence free survival rate was 81.6%, which dropped to 66.5% at 10-year follow-up.
Conclusions: Periodic imaging surveillance is essential after excision of third ventricular colloid cysts to detect asymptomatic recurrences because these lesions may recur several years after presumed total or near-total excision. Recurrences associated with clinical symptoms or demonstrated growth on serial follow-up require intervention; however, reoperation may be cautiously deferred in patients with stable asymptomatic recurrences.
Keywords: Long-term follow-up; Microsurgical excision; Recurrence; Third ventricular colloid cysts.
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