Primary Gamma-knife Radiosurgery for Quasi-symptomatic Third Ventricular Colloid Cyst: A Case Report and Review of Literature

Primary Gamma-knife Radiosurgery for Quasi-symptomatic Third Ventricular Colloid Cyst: A Case Report and Review of Literature | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Primary Gamma-knife Radiosurgery for Quasi-symptomatic Third Ventricular Colloid Cyst: A Case Report and Review of Literature Manjul Tripathi, Onam Verma, Rupinder Kaur, Narendra Kumar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3834535/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Colloid cysts are rare benign tumors most commonly occurring in the third ventricle. Conventional open surgery for symptomatic cases may be associated with complications and a high rate of recurrence. Minimally symptomatic or incidental colloid cyst pose as a treatment dilemma due to a slight but devastating possibility of late progression and sudden death. Stereotactic radiosurgery may be the middle-of-the-road solution in such a vignette. Given its safety profile and clinico-radiological efficacy, GKRS may find a role in the treatment protocol of colloid cyst. Stereotactic radiosurgery Hydrocephalus Sudden death Shunting Endoscopy Stereotactic aspiration Figures Figure 1 Introduction A colloid cyst is a slow growing benign tumor of neuroepithelial origin, and comprise 0.5–1.5% of all intra-cranial tumors with an estimated incidence of 3.2per million per year[ 1 , 8 , 17 ]. Hydrocephalus was present in 48% of symptomatic patients manifesting headache, nausea, vomiting, visual changes, ataxia and cognitive decline[ 1 ]. There is well-documented risk of sudden death in 3.1–21% previously asymptomatic patients presenting with acute hydrocephalus (HCP)[ 1 , 5 ]. They deteriorate and progress to death despite rapid institution of appropriate measures. Symptomatic colloid cyst may be treated by craniotomy and excision, endoscopic aspiration and resection, and/or stereotactic aspiration. A host of complications of these surgeries include intraventricular hemorrhage, memory impairment, hemiparesis, dysphagia and a long duration of hospital stay. In the past, Gamma-knife Radiosurgery(GKRS) has been used in colloid cyst in five cases, where GKRS was preceded by either shunt diversion or stereotactic aspiration[ 11 , 13 ]. Long term radiological follow up was only available for two cases(Table 1). Here,we present a seven-year clinico-radiological follow up of colloid cyst treated with primary GKRS with no CSF diversion and discuss possible roles of stereotactic surgery in management of colloid cyst. Case presentation Case summary An eleven-year old male presented to us with a six-month history of intermittent bi-frontal headache with no features of raised ICP in March2016. The patient gave no history of nausea vomiting, diurnal or postural variations, visual disturbances. The history was not suggestive of migraine or family history of migraine or phakomatoses. Neurological and neuropsychological assessment were unremarkable. There was no papilledema or optic atrophy on fundus evaluation. Biochemical and hormonal evaluation were within normal limit. The patient’s phenotype was negative for any neurocutaneous markers. MRI brain showed an 8*8mm round lesion along the roof of third ventricle at the level of foramen of Monro. The lesion being T1hyperintense/T2hypoisointense with no diffusion restriction and no post-contrast enhancement merited the diagnosis of colloid cyst. Management Patient and guardians were explained about the disease natural history and treatment options and were unwilling for any invasive surgical. The lack of literature on use of GKRS in colloid cysts was expounded to the patient. He underwent frame based single session GKRS covering Total target volume0.48cc with18Gy@50% with Leksell Perfexion(Elekta Ltd. Sweden) in June2016. Follow-up Two-month clinical follow-up showed resolution of headache. Serial radiology at one, two, and five years showed gradual reduction of the colloid cyst. Near disappearance of the cyst was noted at seven years follow up in July 2023(Fig. 1). Discussion Stereotactic Radiosurgery(SRS) has been used in the past to treat emergent colloid cysts secondary to shunt diversion or stereotactic aspiration. In the first case, the cyst received a radiation dose of13Gy@65% 12 weeks after shunt diversion. Follow-up at five-years did not show decrease in cyst size[ 11 ]. Morgan et al. describe use of LINAC based SRS(16-18Gy) following stereotactic aspiration of cyst, with a treatment interval ranging between 5 days to 14 weeks[ 13 ]. Long term radiological follow-up showing no recurrence after six years is only available for two of the four reported cases and response to GKRS was favorable in cases where radiation was delivered within a week of stereotactic aspiration. One patient showed complete disappearance, while another had clinical improvement and refused for any follow-up radiology[ 13 ]. With the limited data we do not suggest an ideal prescription dose for colloid cyst. However, in view of its close vicinity to the limbic system it would be prudent to choose a dose and modality with sharp dose fall-out avoiding critical neurovascular structures. Numerous studies have compared various surgical options available for colloid cysts viz open surgical excision, stereotactic aspiration and/or endoscopic approach. Open surgery may lead to complications either due to approach(transcallosal) or injury to fornix. Endoscopic surgery is preferred for its merits such as reduced operative morbidity, lower costs, and reduced hospital stay [ 2 , 16 ]. As compared to microsurgery, endoscopic surgery was found to have a higher recurrence rate(3.91%vs1.48%) and reoperation rate(3.0%vs0.8%). As per Mathieson et al, 80% colloid cysts recur following standalone stereotactic aspiration with 61% of these recurrences being within 2 months of the procedure[ 12 ]. Stereotactic aspiration sans close radiological monitoring is inadvisable as it is associated with recurrence and subsequent progression to cerebral herniation prior to reoperation as seen in 4 cases[ 12 ]. Another study showed median time to radiological recurrence was 42 months, while symptomatic recurrence occurred 184 months of complete stereotactic aspiration[ 18 ]. This gives way to an approach that curtails tumor growth safely with high precision & efficacy and a low risk of recurrence. Colloid cysts make an ideal target for GKRS given their shape, size and intra-ventricular location. Being a benign(low alpha/beta) entity colloid cyst remains a suitable target with single session SRS in view of absence of any report highlighting post radiation histopathological changes. Authors cannot comment on the pathophysiology of shrinkage of cyst contents and its volume. GKRS has already been found effective for similar other pathologies such as follicular pituitary cysts, Rathke cleft cysts etc. Immunohistochemically, colloid cysts are very similar to aforementioned cysts, which may explain the similar efficacy in colloid cysts as well [ 7 , 9 , 10 ]. 40–60% colloid cysts may be asymptomatic at the time of first diagnosis. A recent systematic review showed a 5–15% chance of progression after 5 years of expectant management of incidentally detected colloid cysts[ 14 ]. At the same time, accessibility and availability of modern imaging has led to an increase in colloid cysts identified incidentally. Due to the rarity of the disease, there is a lack of guidelines, and the decision to operate falls upon the preference of the surgeon. Colloid cyst risk score (CCRS) is a validated prognostication method to stratify the risk of obstructive HCP in symptomatic lesions. While surgical intervention in warranted in all high-risk patients with CCRS \(\ge\) 4, lesions scoring \(\le\) 2 are considered low-risk and managed expectantly. According to Beaumont et al, CCRS 3 forms the intermediate risk category and 3 out of 5 such incidental lesions progress to CCRS 5 in 5-years[ 1 ]. Studies also show that patients who experience rapid deterioration and death tend to be younger, have long standing symptoms and have cysts measuring at least 8mm in diameter[ 3 , 4 , 15 ]. The growth of colloid cyst in its natural history is erratic showing late progression 7–20 years after incidental discovery[ 6 ]. With the limited available evidence, authors do not propose GKRS as a substitute to the gold standard approaches. However, it remains a promising supplementary tool for the management of residual, or recurrent cysts, infrequently it may be considered as a primary treatment option for patients falling in the intermediate/low risk groups with explained risks, need of follow-up and chances of delayed progression in the long term to the patients unwilling for any invasive surgical intervention. In this era of evidence-based medicine, and informed decision making, the risk of sudden death should be expounded to the patient with an emphasis proportional to the possibility and gravity of this complication. Future studies should aim to study long-term response rates of colloid cysts to primary and secondary GKRS and elucidate its efficacy and safety profile. Conclusion Primary gamma-knife radiosurgery is a viable treatment option for intermediate risk colloid cysts, especially in low-income set ups with poor patient compliance for long term radiological follow-up. Secondary to open surgery, shunt diversion or stereotactic aspiration,GKRS should be employed to prevent disease recurrence. Declarations Equal first authorship to Manjul Tripathi and Onam Verma The patient’s parents have consented for the publication of this report. Funding- Nothing to disclose Acknowledgement Nil Presentation at a conference: Not presented anywhere Clinical Trial Registration Number: Not required References Beaumont TL, Limbri DD, Rich KM, Wippold FJ, Dacey RG (2016) Natural history of colloid cysts of the third ventricle. J. Neurosurg. 125:1420-1430. DOI: 10.3171/2015.11.JNS151396 Beaumont TL, Limbrick DD, Patel B, Chicoine MR, Rich KM, Dacey RG (2022) Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection. J. Neurosurg 11:1–9 . Buttner A, Winkler PA, Eisenmenger W, Weis S (1997) Colloid cysts of the third ventricle with fatal outcome: a report of two cases and review of literature. Int J Legal Med 110:260-266 Camacho A, Abernathey CD, Kelly PJ, Laws ER (1989) Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurg 24:693-700 De Witt Hamer PC, Verstegen MJT, De Haan RJ, Vandertop WP, Thomeer RTQM, Mooij JJA, Van Furth WR (2002) High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg 96:1041-1045 DOI: 10.3171/jns.2002.96.6.1041 Dhaliwal T, Kow CY, Praeger A, Danks RA (2022) Late progression of incidental colloid cysts-two case reports and a review of literature. Interndiscip. Neurosurg, 29. Graziani N, Dufour H, Figarella-Branger D, Donnet A, Bouillot P, Grisoli F (1995) Do the suprasellar neurenteric cyst, the Rathke cleft cyst and the colloid cyst constitute a same entity? Acta Neurochir133:174–180. DOI: 10.1007/BF01420070 Hernesniemi J, Leivo S. (1996) Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcallosal microsurgery. Surg Neurol 45:2-14. DOI: 10.1016/0090-3019(95)00379-7 Kondziolka D, Bernstein K, Lee CC, Yang HC, Liscak R, May J, Martínez-Álvarez R, Martínez-Moreno N, Bunevicius A, Sheehan JP (2022) Stereotactic radiosurgery for Rathke's cleft cysts: an international multicenter study. J Neurosurg 11:1-6. DOI: 10.3171/2021.12.JNS212108 Lach B, Scheithauer BW, Gregor A, Wick MR (1993) Colloid cyst of the third ventricle. A comparative immunohistochemical study of neuraxis cysts and choroid plexus epithelium. J Neurosurg 78:101– 111. DOI: 10.3171/jns.1993.78.1.0101 Lustgarten L (2015) Is there room for stereotactic radiosurgery as an option for third ventricular colloid cysts in patients refusing surgery? A case report and some therapeutic considerations. Surg Neurol Int. 6:402-405. DOI: 10.4103/2152-7806.166175 Mathiesen T, Grane P, Lindquist C, Von Holst H (1993). High recurrence rate following aspiration of colloid cysts in the third ventricle. J Neurosurg 78 :748–752. DOI: 10.3171/jns.1993.78.5.0748 Morgan JP, McGraw SC, Asfora WT (2018) Treatment of colloid cyst of the third ventricle by stereotactic aspiration followed by radiosurgery: Report of four cases. Surg Neurol Int. 9:3. DOI: 10.4103/sni.sni_180_17 O’Neill AH, Gragnaniello C, Lai LT (2018) Natural history of incidental colloid cysts of the third ventricle: A systematic review. J Clin Neurosci. 53:122-126. DOI: 10.1016/j.jocn.2018.04.061 Ryder JW, Kleinschmidt-DeMasters BK, Keller TS (1986) Sudden deterioration and death in patients with benign tumors of the third ventricle area. J Neurosurg 64:216-223. Shiekh AB, Mendelson ZS, Liu JK (2014) Endoscopic versus microsurgical resection: a systematic review and meta-analysis of 1278 patients. World Neurosurg 82:1187-1197 Tubbs RS, Oakes P, Maran IS, Salib C, Loukas M (2014) The foramen of Monro: a review of its anatomy, history, pathology, and surgery. Child’s Nerv Syst 30:1645-1649 DOI: 10.1007/s00381-014-2512-6 Vedantam R (2012) Rate of recurrence following stereotactic aspiration of colloid cysts of the third ventricle. Stereotact Funct Neurosurg 90: 37-44. DOI: 10.1159/000334670 Table 1 Table 1: Literature review of Published cases of Colloid cysts treated with Gamma-knife Radiosurgery. HCP = Hydrocephalus NPH = Normal Pressure Hydrocephalus Article Case Age/ Sex Presentation MRI Findings CCRS score Lesion size (mm) Pre-GKRS Procedures Interval b/w GKRS and pre-GKRS procedures (in weeks) GKRS parameters Clinico-radiological Follow-up post Gamma-knife radiosurgery VP shunting Stereotactic Aspiration Time (in yrs) Clinical Time Radiology Lustgarten (2016) 1 39/F NPH, headache,Wide based gait with unsteadiness and slow steps, urinary incontinence Severe ventricular dilatation - HCP with third ventricular colloid cyst 4 + - 12 13Gy to 65% Isodose line Leksell Gamma-knife model 4c Elekta Ltd. 5 Asymptomatic 5years No evidence of growth Morgan et al (2018) 1 23/M Headache, blurred vision, diplopia Mild ventricular dilatation – lesion in upper anterior third ventricle. 4 11 - + 14 18Gy LINAC 10 Asymptomatic 6months 7.3mm 1 50/F Headache, dizziness, memory loss (recall memory impacted) Antero-superior third ventricular colloid cyst in the region of the F Monro 4 12 - + 1 16Gy LINAC 6 Asymptomatic 6years No recurrence 1 42/F Headache, Nausea and vomiting Anterior ventricle at the foramen of Monro 4 7.7 - + 1 16Gy LINAC 4 Asymptomatic NA NA 1 29/F Headache, Nausea and vomiting Colloid cyst in third ventricle at the foramen Monro and mild dilatation of the right lateral ventricle 4 13 - + 2 16Gy LINAC 6 Persistent migraine 6 years No recurrence Present case 1 11/M Severe Headache – bilateral and frontal for 6 months Colloid cyst at the roof of third ventricle in region of the foramen Monro 3 8 - - NA 18Gy@50% 7 Asymptomatic 7years Near disappearance Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3834535","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":265405891,"identity":"dfc995bc-9b16-42be-8f1f-c59d2dd7cab6","order_by":0,"name":"Manjul Tripathi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYDCCAyCCh0GGgYGxAcTl4QcJJBQQ1sLDA9aScIBHEqQzwYCQFgaQFrDpBxgMwCJ4tPDdPp34uUDmMI+99OG2Bz9/3JExPr868cMDAwZ5frEDWLVInsvdLD2D5zAPD19iu2FPwjMesxtvN0sAHWY4c3YCVi0GZ3g3SPOAtPAwtknwJBwGajm7AaQlweA2Ti2bf8O0SP4BajGecXbzDwJatsFtkQbZYsDfuw2vLZJALdY8POk8PGcY241l0g7zSNzg3WaRYCCB0y98QIfd5u2xlmPvYX/28I3NYXv+/rObb/6osJHnl8auBQwYe8AUG4QnAVYpgVs5GPxA1sJ/gIDqUTAKRsEoGGkAAKAmXNZ6BNQaAAAAAElFTkSuQmCC","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Manjul","middleName":"","lastName":"Tripathi","suffix":""},{"id":265405892,"identity":"e31035fc-9676-4c35-80cd-3d868706376e","order_by":1,"name":"Onam Verma","email":"","orcid":"","institution":"Government Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Onam","middleName":"","lastName":"Verma","suffix":""},{"id":265405893,"identity":"5c9908b4-2064-4ffb-b857-7763a84327f3","order_by":2,"name":"Rupinder Kaur","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Rupinder","middleName":"","lastName":"Kaur","suffix":""},{"id":265405894,"identity":"2bb9c8db-21c8-4e42-8af8-0bbc646900a6","order_by":3,"name":"Narendra Kumar","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Narendra","middleName":"","lastName":"Kumar","suffix":""}],"badges":[],"createdAt":"2024-01-04 12:29:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3834535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3834535/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49330000,"identity":"dd3d18c2-a722-4532-ba48-670f2fde46c6","added_by":"auto","created_at":"2024-01-08 18:45:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":503666,"visible":true,"origin":"","legend":"\u003cp\u003eA) Third ventricular colloid cyst of 0.46 cc volume treated with 18Gy marginal dose in 2016; B,C,D show gradual volumetric reduction on follow-up MRI in 2017, 2018, 2021 respectively. E) Shows complete cyst disappearance on seven follow-up MRI.\u003c/p\u003e","description":"","filename":"Colloidcystimaging.png","url":"https://assets-eu.researchsquare.com/files/rs-3834535/v1/c12a10db6a3ae11c099b98f8.png"},{"id":50273814,"identity":"64bd2a6a-7462-498d-80ed-8206f85b6ffb","added_by":"auto","created_at":"2024-01-28 21:22:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":939921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3834535/v1/83659848-1d55-4abf-9c86-1b09a37d8405.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Primary Gamma-knife Radiosurgery for Quasi-symptomatic Third Ventricular Colloid Cyst: A Case Report and Review of Literature","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA colloid cyst is a slow growing benign tumor of neuroepithelial origin, and comprise 0.5\u0026ndash;1.5% of all intra-cranial tumors with an estimated incidence of 3.2per million per year[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Hydrocephalus was present in 48% of symptomatic patients manifesting headache, nausea, vomiting, visual changes, ataxia and cognitive decline[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. There is well-documented risk of sudden death in 3.1\u0026ndash;21% previously asymptomatic patients presenting with acute hydrocephalus (HCP)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. They deteriorate and progress to death despite rapid institution of appropriate measures.\u003c/p\u003e \u003cp\u003eSymptomatic colloid cyst may be treated by craniotomy and excision, endoscopic aspiration and resection, and/or stereotactic aspiration. A host of complications of these surgeries include intraventricular hemorrhage, memory impairment, hemiparesis, dysphagia and a long duration of hospital stay.\u003c/p\u003e \u003cp\u003eIn the past, Gamma-knife Radiosurgery(GKRS) has been used in colloid cyst in five cases, where GKRS was preceded by either shunt diversion or stereotactic aspiration[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Long term radiological follow up was only available for two cases(Table\u0026nbsp;1). Here,we present a seven-year clinico-radiological follow up of colloid cyst treated with primary GKRS with no CSF diversion and discuss possible roles of stereotactic surgery in management of colloid cyst.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCase summary\u003c/h2\u003e \u003cp\u003eAn eleven-year old male presented to us with a six-month history of intermittent bi-frontal headache with no features of raised ICP in March2016. The patient gave no history of nausea vomiting, diurnal or postural variations, visual disturbances. The history was not suggestive of migraine or family history of migraine or phakomatoses. Neurological and neuropsychological assessment were unremarkable. There was no papilledema or optic atrophy on fundus evaluation. Biochemical and hormonal evaluation were within normal limit. The patient\u0026rsquo;s phenotype was negative for any neurocutaneous markers. MRI brain showed an 8*8mm round lesion along the roof of third ventricle at the level of foramen of Monro. The lesion being T1hyperintense/T2hypoisointense with no diffusion restriction and no post-contrast enhancement merited the diagnosis of colloid cyst.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eManagement\u003c/h2\u003e \u003cp\u003ePatient and guardians were explained about the disease natural history and treatment options and were unwilling for any invasive surgical. The lack of literature on use of GKRS in colloid cysts was expounded to the patient. He underwent frame based single session GKRS covering Total target volume0.48cc with18Gy@50% with Leksell Perfexion(Elekta Ltd. Sweden) in June2016.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eTwo-month clinical follow-up showed resolution of headache. Serial radiology at one, two, and five years showed gradual reduction of the colloid cyst. Near disappearance of the cyst was noted at seven years follow up in July 2023(Fig.\u0026nbsp;1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eStereotactic Radiosurgery(SRS) has been used in the past to treat emergent colloid cysts secondary to shunt diversion or stereotactic aspiration. In the first case, the cyst received a radiation dose of13Gy@65% 12 weeks after shunt diversion. Follow-up at five-years did not show decrease in cyst size[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Morgan et al. describe use of LINAC based SRS(16-18Gy) following stereotactic aspiration of cyst, with a treatment interval ranging between 5 days to 14 weeks[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Long term radiological follow-up showing no recurrence after six years is only available for two of the four reported cases and response to GKRS was favorable in cases where radiation was delivered within a week of stereotactic aspiration. One patient showed complete disappearance, while another had clinical improvement and refused for any follow-up radiology[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. With the limited data we do not suggest an ideal prescription dose for colloid cyst. However, in view of its close vicinity to the limbic system it would be prudent to choose a dose and modality with sharp dose fall-out avoiding critical neurovascular structures.\u003c/p\u003e \u003cp\u003eNumerous studies have compared various surgical options available for colloid cysts viz open surgical excision, stereotactic aspiration and/or endoscopic approach. Open surgery may lead to complications either due to approach(transcallosal) or injury to fornix. Endoscopic surgery is preferred for its merits such as reduced operative morbidity, lower costs, and reduced hospital stay [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As compared to microsurgery, endoscopic surgery was found to have a higher recurrence rate(3.91%vs1.48%) and reoperation rate(3.0%vs0.8%). As per Mathieson et al, 80% colloid cysts recur following standalone stereotactic aspiration with 61% of these recurrences being within 2 months of the procedure[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Stereotactic aspiration sans close radiological monitoring is inadvisable as it is associated with recurrence and subsequent progression to cerebral herniation prior to reoperation as seen in 4 cases[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another study showed median time to radiological recurrence was 42 months, while symptomatic recurrence occurred 184 months of complete stereotactic aspiration[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This gives way to an approach that curtails tumor growth safely with high precision \u0026amp; efficacy and a low risk of recurrence.\u003c/p\u003e \u003cp\u003eColloid cysts make an ideal target for GKRS given their shape, size and intra-ventricular location. Being a benign(low alpha/beta) entity colloid cyst remains a suitable target with single session SRS in view of absence of any report highlighting post radiation histopathological changes. Authors cannot comment on the pathophysiology of shrinkage of cyst contents and its volume. GKRS has already been found effective for similar other pathologies such as follicular pituitary cysts, Rathke cleft cysts etc. Immunohistochemically, colloid cysts are very similar to aforementioned cysts, which may explain the similar efficacy in colloid cysts as well [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e40\u0026ndash;60% colloid cysts may be asymptomatic at the time of first diagnosis. A recent systematic review showed a 5\u0026ndash;15% chance of progression after 5 years of expectant management of incidentally detected colloid cysts[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. At the same time, accessibility and availability of modern imaging has led to an increase in colloid cysts identified incidentally. Due to the rarity of the disease, there is a lack of guidelines, and the decision to operate falls upon the preference of the surgeon.\u003c/p\u003e \u003cp\u003eColloid cyst risk score (CCRS) is a validated prognostication method to stratify the risk of obstructive HCP in symptomatic lesions. While surgical intervention in warranted in all high-risk patients with CCRS\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\ge\\)\u003c/span\u003e\u003c/span\u003e4, lesions scoring \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\le\\)\u003c/span\u003e\u003c/span\u003e2 are considered low-risk and managed expectantly. According to Beaumont et al, CCRS 3 forms the intermediate risk category and 3 out of 5 such incidental lesions progress to CCRS 5 in 5-years[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Studies also show that patients who experience rapid deterioration and death tend to be younger, have long standing symptoms and have cysts measuring at least 8mm in diameter[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The growth of colloid cyst in its natural history is erratic showing late progression 7\u0026ndash;20 years after incidental discovery[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the limited available evidence, authors do not propose GKRS as a substitute to the gold standard approaches. However, it remains a promising supplementary tool for the management of residual, or recurrent cysts, infrequently it may be considered as a primary treatment option for patients falling in the intermediate/low risk groups with explained risks, need of follow-up and chances of delayed progression in the long term to the patients unwilling for any invasive surgical intervention. In this era of evidence-based medicine, and informed decision making, the risk of sudden death should be expounded to the patient with an emphasis proportional to the possibility and gravity of this complication.\u003c/p\u003e \u003cp\u003eFuture studies should aim to study long-term response rates of colloid cysts to primary and secondary GKRS and elucidate its efficacy and safety profile.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePrimary gamma-knife radiosurgery is a viable treatment option for intermediate risk colloid cysts, especially in low-income set ups with poor patient compliance for long term radiological follow-up. Secondary to open surgery, shunt diversion or stereotactic aspiration,GKRS should be employed to prevent disease recurrence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEqual first authorship to Manjul Tripathi and Onam Verma\u003c/p\u003e\n\u003cp\u003eThe patient\u0026rsquo;s parents have consented for the publication of this report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding-\u003c/strong\u003eNothing to disclose\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePresentation at a conference:\u003c/strong\u003e Not presented anywhere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration Number:\u003c/strong\u003e Not required\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBeaumont TL, Limbri DD, Rich KM, Wippold FJ, Dacey RG (2016) Natural history of colloid cysts of the third ventricle. J. Neurosurg. 125:1420-1430. DOI: 10.3171/2015.11.JNS151396\u003c/li\u003e\n\u003cli\u003eBeaumont TL, Limbrick DD, Patel B, Chicoine MR, Rich KM, Dacey RG (2022) Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection. J. Neurosurg 11:1\u0026ndash;9 . \u003c/li\u003e\n\u003cli\u003eButtner A, Winkler PA, Eisenmenger W, Weis S (1997) Colloid cysts of the third ventricle with fatal outcome: a report of two cases and review of literature. Int J Legal Med 110:260-266 \u003c/li\u003e\n\u003cli\u003eCamacho A, Abernathey CD, Kelly PJ, Laws ER (1989) Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurg 24:693-700\u003c/li\u003e\n\u003cli\u003eDe Witt Hamer PC, Verstegen MJT, De Haan RJ, Vandertop WP, Thomeer RTQM, Mooij JJA, Van Furth WR (2002) High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg 96:1041-1045 DOI: 10.3171/jns.2002.96.6.1041\u003c/li\u003e\n\u003cli\u003eDhaliwal T, Kow CY, Praeger A, Danks RA (2022) Late progression of incidental colloid cysts-two case reports and a review of literature. Interndiscip. Neurosurg, 29. \u003c/li\u003e\n\u003cli\u003eGraziani N, Dufour H, Figarella-Branger D, Donnet A, Bouillot P, Grisoli F (1995) Do the suprasellar neurenteric cyst, the Rathke cleft cyst and the colloid cyst constitute a same entity? Acta Neurochir133:174\u0026ndash;180. DOI: 10.1007/BF01420070\u003c/li\u003e\n\u003cli\u003eHernesniemi J, Leivo S. (1996) Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcallosal microsurgery. Surg Neurol 45:2-14. DOI: 10.1016/0090-3019(95)00379-7\u003c/li\u003e\n\u003cli\u003eKondziolka D, Bernstein K, Lee CC, Yang HC, Liscak R, May J, Mart\u0026iacute;nez-\u0026Aacute;lvarez R, Mart\u0026iacute;nez-Moreno N, Bunevicius A, Sheehan JP (2022) Stereotactic radiosurgery for Rathke\u0026apos;s cleft cysts: an international multicenter study. J Neurosurg 11:1-6. DOI: 10.3171/2021.12.JNS212108\u003c/li\u003e\n\u003cli\u003eLach B, Scheithauer BW, Gregor A, Wick MR (1993) Colloid cyst of the third ventricle. A comparative immunohistochemical study of neuraxis cysts and choroid plexus epithelium. \u003cem\u003eJ Neurosurg\u003c/em\u003e 78:101\u0026ndash; 111. DOI: 10.3171/jns.1993.78.1.0101\u003c/li\u003e\n\u003cli\u003eLustgarten L (2015) Is there room for stereotactic radiosurgery as an option for third ventricular colloid cysts in patients refusing surgery? A case report and some therapeutic considerations. Surg Neurol Int. 6:402-405. DOI: 10.4103/2152-7806.166175\u003c/li\u003e\n\u003cli\u003eMathiesen T, Grane P, Lindquist C, Von Holst H (1993). High recurrence rate following aspiration of colloid cysts in the third ventricle. J Neurosurg \u003cem\u003e78\u003c/em\u003e:748\u0026ndash;752. DOI: 10.3171/jns.1993.78.5.0748\u003c/li\u003e\n\u003cli\u003eMorgan JP, McGraw SC, Asfora WT (2018) Treatment of colloid cyst of the third ventricle by stereotactic aspiration followed by radiosurgery: Report of four cases. Surg Neurol Int. 9:3. DOI: 10.4103/sni.sni_180_17\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neill AH, Gragnaniello C, Lai LT (2018) Natural history of incidental colloid cysts of the third ventricle: A systematic review. J Clin Neurosci. 53:122-126. DOI: 10.1016/j.jocn.2018.04.061\u003c/li\u003e\n\u003cli\u003eRyder JW, Kleinschmidt-DeMasters BK, Keller TS (1986) Sudden deterioration and death in patients with benign tumors of the third ventricle area. J Neurosurg 64:216-223.\u003c/li\u003e\n\u003cli\u003eShiekh AB, Mendelson ZS, Liu JK (2014) Endoscopic versus microsurgical resection: a systematic review and meta-analysis of 1278 patients. World Neurosurg 82:1187-1197\u003c/li\u003e\n\u003cli\u003eTubbs RS, Oakes P, Maran IS, Salib C, Loukas M (2014) The foramen of Monro: a review of its anatomy, history, pathology, and surgery. Child\u0026rsquo;s Nerv Syst 30:1645-1649 DOI: 10.1007/s00381-014-2512-6\u003c/li\u003e\n\u003cli\u003eVedantam R (2012) Rate of recurrence following stereotactic aspiration of colloid cysts of the third ventricle. Stereotact Funct Neurosurg 90: 37-44. DOI: 10.1159/000334670\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1: Literature review of Published cases of Colloid cysts treated with Gamma-knife Radiosurgery. \u003c/p\u003e\u003cp\u003eHCP = Hydrocephalus\u003c/p\u003e\u003cp\u003eNPH = Normal Pressure Hydrocephalus\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"15\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArticle\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge/\u003c/p\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePresentation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMRI Findings\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCCRS score\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLesion size (mm)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ePre-GKRS Procedures\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eInterval b/w GKRS and pre-GKRS procedures (in weeks)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGKRS parameters\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c15\" namest=\"c12\"\u003e \u003cp\u003eClinico-radiological Follow-up post Gamma-knife radiosurgery\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVP shunting\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStereotactic Aspiration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003cp\u003e(in yrs)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eRadiology\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLustgarten (2016)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39/F\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNPH, headache,Wide based gait with unsteadiness and slow steps, urinary incontinence\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSevere ventricular dilatation - HCP with third ventricular colloid cyst\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13Gy to 65% Isodose line\u003c/p\u003e \u003cp\u003eLeksell Gamma-knife model 4c Elekta Ltd.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo evidence of growth\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorgan et al (2018)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23/M\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHeadache, blurred vision, diplopia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMild ventricular dilatation – lesion in upper anterior third ventricle.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18Gy LINAC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e6months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e7.3mm\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50/F\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHeadache, dizziness, memory loss (recall memory impacted)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAntero-superior third ventricular colloid cyst in the region of the F Monro\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16Gy LINAC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e6years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo recurrence\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42/F\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHeadache, Nausea and vomiting\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnterior ventricle at the foramen of Monro\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16Gy\u003c/p\u003e \u003cp\u003eLINAC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29/F\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHeadache, Nausea and vomiting\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eColloid cyst in third ventricle at the foramen Monro and mild dilatation of the right lateral ventricle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16Gy\u003c/p\u003e \u003cp\u003eLINAC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePersistent migraine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e6 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo recurrence\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent case\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/M\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere Headache – bilateral and frontal for 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eColloid cyst at the roof of third ventricle in region of the foramen Monro\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18Gy@50%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e7years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNear disappearance\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Stereotactic radiosurgery, Hydrocephalus, Sudden death, Shunting, Endoscopy, Stereotactic aspiration","lastPublishedDoi":"10.21203/rs.3.rs-3834535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3834535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eColloid cysts are rare benign tumors most commonly occurring in the third ventricle. Conventional open surgery for symptomatic cases may be associated with complications and a high rate of recurrence. Minimally symptomatic or incidental colloid cyst pose as a treatment dilemma due to a slight but devastating possibility of late progression and sudden death. Stereotactic radiosurgery may be the middle-of-the-road solution in such a vignette. Given its safety profile and clinico-radiological efficacy, GKRS may find a role in the treatment protocol of colloid cyst.\u003c/p\u003e","manuscriptTitle":"Primary Gamma-knife Radiosurgery for Quasi-symptomatic Third Ventricular Colloid Cyst: A Case Report and Review of Literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-08 18:45:28","doi":"10.21203/rs.3.rs-3834535/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03298ae1-2c9a-42a7-966f-0738d662a058","owner":[],"postedDate":"January 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-28T21:14:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-08 18:45:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3834535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3834535","identity":"rs-3834535","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}