Endoscopic versus microsurgical resection of colloid cysts: a systematic review and meta-analysis of 1,278 patients

Abstract

Objective: Colloid cysts of the third ventricle have been successfully treated with transcranial microsurgical approaches. However, the endoscopic approach has recently been advocated as a lesser invasive technique. We conducted a systematic review and meta-analysis of published studies to compare the outcomes between the two approaches.

Methods: A PubMED search of contemporary literature (1990-2014) was performed to identify surgical series of open and endoscopic treatment of colloid cysts. Relevant articles were identified and data were extracted concerning surgical treatment, extent of resection, and outcomes.

Results: A meta-analysis was performed for recurrence rates based on treatment strategy. A total of 583 patients were included in the microsurgical group, and 695 patients in the endoscopic group. The microsurgical approach was found to have a significantly higher gross total resection rate (96.8% vs. 58.2%; P < 0.0001), lower recurrence rate (1.48% vs. 3.91%; P = 0.0003), and lower reoperation rate (0.38% vs. 3.0%; P = 0.0006) compared with the endoscopic group. There was no significant difference in mortality rate (1.4% vs. 0.6%) or shunt dependency (6.2% vs. 3.9%) between the two groups. The overall morbidity rate was lower in the endoscopic group (10.5%) than in the microsurgery group (16.3%). Within the microsurgery group, the transcallosal approach had a lower overall morbidity rate (14.4%) than the transcortical approach (24.5%).

Conclusions: Microsurgical resection of colloid cysts is associated with a higher rate of complete resection, lower rate of recurrence, and fewer reoperations than with endoscopic removal. However, the rate of morbidity is higher with microsurgery than with endoscopy.

Keywords: Colloid cyst; Microsurgery; Neuroendoscopy; Systematic review; Third ventricle.