Colloid Cysts

Colloid cysts are benign tumors that are amenable to curative neurosurgical resection. They must be diagnosed promptly before symptoms develop that can lead to acute conditions and sudden death. They are rare tumors but, with the advent of neuroradiological imaging, can be identified incidentally when imaging is performed for other reasons. They typically present in midlife, although pediatric diagnoses are known. They are located most frequently in the third ventricle and can cause variable symptoms due to intermittent obstruction of CSF pathways.

Patients may have weakness in the legs not associated with loss of consciousness, headache that is progressive, or paradoxical lightning headache that is relieved by positional changes of the head. Papilledema may be present on examination. Occasionally, patients with colloid cysts present with symptoms consistent with normal pressure hydrocephalus. Imaging with noncontrast CT demonstrates ventricular obstruction and dilatation with a hyperdense mass in the third ventricle. Coronal MRI usually demonstrates the mass in the anterior third ventricle. These tumors can be confused with basilar aneurysms or choroid plexus papilloma, although these lesions are not as hyperdense on noncontrast neuroradiological studies. Management includes immediate attention to hydrocephalus, often with ventricular drainage. Early surgical intervention is recommended to prevent neurological deterioration. y

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