“Atypical Radiological Findings In Colloid Cyst Of Third Ventricle- Rare Findings In Rare Tumour”

“Atypical Radiological Findings In Colloid Cyst Of Third Ventricle- Rare Findings In Rare Tumour” | 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 Research Article “Atypical Radiological Findings In Colloid Cyst Of Third Ventricle- Rare Findings In Rare Tumour” Rajat Verma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3827084/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 Introduction -Colloid cysts are rare intracranial tumours occurring in 3 individuals per million per year. They constitute around 2% (range 0.5 to 3%)3-5 of all primary brain tumours. Materials and methods - We retrospectively studied the imaging of 47 patients of colloid cyst of third ventricle who were admitted in PGIMER, Chandigarh in last 10 years for surgical excision. Of them 31 underwent endoscopic excision while 16 went microsurgical excision. Preoperative NCCT head and MR imaging of all patients were studied. Results- Analysis revealed that in 91.5% cases cyst size was between 1 to 3 cm with mean cyst diameter of 17.55±8.32mm. We encountered 3 giant cysts (>3 cm) in our study. On NCCT head, cyst was hyperdense in 85.11% of cases, hypodense in 4.25% of cases and isodense in 10.64%. On T1 weighted MRI sequences, 42.55% of cysts were hyperintense, 31.92% were hypointense, while 25.53% were isointense. On T2 weighted sequences 57.45% of cysts were hyperintense, 38.30% were hypointense while 4.25% were isointense. Peripheral contrast enhancement was present in 8.51% of cysts. Two cysts showed intracystic haemorrhage, out of which one was giant cyst and one showed intramural nodule. Conclusion- This article describes case studies of patients with atypical findings in imaging like giant colloid cysts, peripheral contrast enhancement, intracystic haemorrhage & intramural nodule. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Colloid cyst is a benign, epithelial lined, mucin containing cyst usually located in anterosuperior part of third ventricle roof just posterior to foramen of Monro. They are rare intracranial masses occurring in 3 individuals per million per year. 1 They constitute around 2% (range 0.5 to 3%) 3-5 of all primary brain tumours and 15 to 20% 2-5 of all intraventricular masses. 80% of colloid cyst are found in 30-60 years age 2 , most of them are identified in middle age (30-50 years) 6 although 8% 5 are identified in paediatric age group. It is rare in infancy & childhood. 7 Till 1994 only 37 cases were described. 8 It is either discovered in asymptomatic patients as incidental finding on imaging or presents with features of raised intracranial pressure in symptomatic patients. Rarely they have been reported to cause sudden death 9 . They are usually 1-3 cm in size. Giant colloid cysts (>3cm) are rare findings. Mixed array of goblet and epithelial cells which lines the colloid cyst secretes the proteinaceous mucinous material which determines the imaging characters of cyst. In addition, cyst cavities may contain blood degradation products and cholesterol crystals. The fibrous walls are lined by simple or pseudostratified epithelial cells (which may be flattened cuboidal or low columnar) which rests on a thin capsule of collagen and fibroblasts. 10 Rarely the cyst wall thickened, vascular and consists of organized hematoma of varying ages. Contents of cyst are most commonly greenish and of variable viscosity. On all modalities, colloid cyst appears as rounded, well demarcated lesion at FOM ranging from few millimetres to 3-4 cm. 5 MRI is superior to CT in fully characterizing the lesion. On CT scan they appear as well delineated, rounded lesion on roof of 3 rd ventricle usually unilocular and hyperdense. Isodense & hypodense cysts are uncommon. 4 On MRI , colloid cyst usually appears hyperintense on T1 and isointense on T2 with peripheral rim enhancement in some cases. On T1 weighted sequences they appear variable 11 with 50% high signal. 12 The rest are hypointense or isointense to adjacent brain. On Gadolinium enhanced T1, they rarely demonstrates thin rim enhancement, but usually this represents enhancement of adjacent and stretched septal veins. 5 On T2 sequences they appear variable 11 , with mostly low T2/T2* signal(short T2), related to thick “motoroil” consistency fluid. 13,14 Some have low central T2 & high peripheral T2 signal. 13 Ventricle size, presence of cavum septum pellucidum et vergae, any abnormal vascular structure (DVA) & location of internal cerebral veins are other important findings gathered from MRI. Haemorrhage within cyst and intramural nodule are uncommon. We describe four cases of peripheral contrast enhancement, three cases of giant colloid cysts, two cases of intacystic haemorrhage and one case of intramural nodule in our study. Materials And Methods 47 patients diagnosed & operated for colloid cyst of 3 rd ventricle in last 10 years in Department of Neurosurgery, PGIMER Chandigarh were included in the study group. Subjects were explained regarding the study and were included in the study only after taking the informed written consent. Pre-operative data and intraoperative details were retrieved from patient case sheets and was double checked with patient history. 31 patients were operated endoscopically while 16 underwent microsurgery. The mean age of study population was 32.23±10.22yrs. Patients were evaluated after a minimum follow up period of 6 months on outpatient basis with questionnaires regarding symptomatology and quality of life. Pre & post operative imaging were studied in detail. Radiological outcome of surgery was analyzed by comparing pre and post op imagings. Total 9 patients out of 47 had atypical radiological findings in their imaging.4 patients showed peripheral contrast enhancement in CE MRI, 3 patients had cyst size more than 3 cm, 2 patients showed hemorrhage within colloid cyst and 1 showed intrmural nodule.1 giant cyst showed intacystic hemorrhage. Results Only 4 out of 47 patients showed peripheral contrast enhancement (table no. 1). This suggests that colloid cyst usually do not show contrast uptake, moreover presence of only peripheral uptake may be due to capsule vascularity and most of times confused with stretched septal veins. All 4 patients were males. Patient name A B C D Age in years 29 50 33 33 Approach Endoscopy Endoscopy Microsurgery Microsurgery NCCT head density Hyperdense Hyperdense Hyperdense Isodense T1 MRI intensity Isointense Isointense Isointense Hypointense T2 MRI intensity Hyperintense Hyperintense Hyperintense Hyperintense Cyst size (mm) 15 28 10 22 Follow up (months) 20 36 11 32 Ventriculomegaly (post op) Absent Absent Absent Absent Residual lesion Absent Present Absent Absent OT time (mins) 120 180 120 240 Hospital stay (days) 2 4 3 4 Table no. 1- showing comparison of relevent variables between 4 patients showing peripheral contrast enhancement. Patient A, 29 yr. male presented with complains of headache, nausea & vomiting. Papilledema was present on examination. On imaging cyst was hyperdense on CT, isointense on T1 and hyperintense on T2 weighted MRI (Figure no. 1). Cyst size was 15mm. and ventriculomegaly was present. Gross Total Endoscopic resection of the cyst was done. Follow up at 20 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion. Figure no. 1- T1 weighted precontrast sagittal(A), postcontrast axial (B) & T2 weighted axial (C) MR images of colloid cyst (arrows) of third ventricle of patient A. Patient B, 50 yr. male presented with complains of headache, cognitive defects, gait disturbances & altered sensorium. Papilledema was present. On imaging cyst was hyperdense on CT, isointense on T1 and hyperintense on T2 weighted MRI (Figure no. 2). Cyst size was 28mm. and ventriculomegaly was present. Subtotal endoscopic resection of the cyst was done. Follow up at 36 months showed complete resolution of all symptoms without any ventriculomegaly but residual lesion was present. Figure no. 2- T1 weighted precontrast (A), postcontrast (B) & T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient B. Patient C, 33 yr. male presented with complains of headache, nausea & vomiting. On imaging cyst was hyperdense on CT, isointense on T1 and hyperintense on T2 weighted MRI (Figure no. 3). Cyst size was 10mm. and ventriculomegaly was present. Gross Total Microsurgical resection of the cyst was done. Follow up at 11 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion. Figure no. 3- T1 weighted precontrast (A), postcontrast (B) & T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient C. Patient D, 33 yr. male presented with complains of headache, nausea, vomiting, cognitive defects, gait disturbances & altered sensorium. Papilledema was present. On imaging cyst was isodense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 4). Cyst size was 22mm. and ventriculomegaly was present. Patient required VP shunt before surgery to relieve hydrocephalus. Gross Total Microsurgical resection of the cyst was done. Follow up at 32 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion. Figure no. 4- T1 weighted precontrast (A), postcontrast (B) & T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient D. 3 out of 47 (table no. 2) patients had giant colloid cysts (cyst diameter >30 mm.) Patient name E F G Age in years 12 26 38 Approach Endoscopy Endoscopy Microsurgery NCCT head density Hyperdense Hypodense Hyperdense T1 MRI intensity Hypointense Hypointense Hyperintense T2 MRI intensity Hyperintense Hyperintense Hypointense Cyst size (mm) 57 35 32 Follow up (months) 36 13 49 Ventriculomegaly (post op) Absent Absent Absent Residual lesion Absent Absent Present OT time (mins) 180 150 300 Hospital stay (days) 6 3 3 Table no. 2- showing comparison of relevent variables between 3 giant cyst patients. Patient E, 12 yr. male presented with complains of headache, nausea, vomiting. Bilateral papilledema was present on eye examination. On imaging cyst was hyperdense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 5). Cyst size was 57mm. and ventriculomegaly was present. Gross Total Endoscopic resection of the cyst was done. Follow up at 36 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion. Figure no. 5-T1 weighted axial (A), coronal (B) & T2 weighted sagittal (C) MR images of giant colloid cyst (arrows) of third ventricle (maximum diameter 57mm.) in patient E. Patient F, 26 yr. male presented with complains of headache and visual disturbances. Bilateral papilledema was present on eye examination. Visual acuity was FC2 in both eyes. Planter reflex was absent. On imaging cyst was hypodense on CT, hypointense on T1 and hyperintense on T2 weighted MRI. Cyst size was 35mm. and ventriculomegaly was present. Endoscopic resection of the cyst was done. Follow up at 13 months showed complete resolution of all symptoms except visual disturbances. Papilledema was absent on follow up. Visual acuity was 6/9 in both eyes. Ventriculomegaly and residual lesion were absent on follow up imaging. Mr G, 38 yr. male presented with complains of headache, nausea, vomiting. Bilateral papilledema was present on eye examination. On imaging cyst was hyperdense on CT, hyperintense on T1 and hypointense on T2 weighted MRI (Figure no. 6). Cyst size was 32mm, intracystic haemorrhage & ventriculomegaly were present on MR imaging. Haemorrhage appeared bright on T1 and dark on T2 showing early subacute duration (4-7 days) after bleeding. Patient required VP shunt before surgery to relieve hydrocephalus. Microsurgical resection of the cyst was done. Follow up at 49 months showed complete resolution of most of the symptoms without any ventriculomegaly. Patient had poor cognitive outcome after surgery as he developed subjective memory disturbances after microsurgery. Objective assessment with PGIMER recent memory scale revealed a score of 5/5 but the patient subjectively complained of forgetting events of recent past. Residual lesion was present on follow up imaging. Figure no. 6-T1 weighted sagittal (A) & T2 weighted axial(B) MR images showing intracystic hemorrhage within the giant colloid cyst (arrows) of third ventricle in patient G. Follow up T1 weighted axial MR image (C) showing residual lesion in same patient. Patient H, 50 yr. male presented with complains of headache, nausea and vomiting. Papilledema was present on fundus examination. On imaging cyst was hyperdense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 7). Blood within the cyst appeared as ill defined, heterogenous content within the cyst with variable intensity in different areas (due to the fact that different areas of clot are in different stages of degeneration) aligning towards the most dependent part of cyst (posterior wall in supine position). Haemorrhage present within the cyst was bright on T1 and dark on T2 showing early subacute phase of blood degeneration. Cyst size was 22mm. and ventriculomegaly was present. Endoscopic resection of the cyst was done. Follow up at 50 months showed complete resolution of all symptoms. Papilledema was absent on follow up. Ventriculomegaly and residual lesion were absent on follow up imaging. Figure no. 7-T1 (A) & T2 (B) weighted sagittal MR images showing hemorrhage (arrows) within the colloid cyst of third ventricle in patient H. Note that the blood is hyperintense on T1 and hypointense on T2 suggesting early subacute period (4-7 days) after bleeding event. Blood is aligned more towards the posterior wall than the floor of cyst (dependent part in supine position). Intramural nodule was found in a single patient I, 45 yr. male who presented with headache, nausea and vomiting. Papilledema was absent on fundus examination. On imaging cyst was hyperdense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 8). Cyst size was 20mm. and ventriculomegaly was present. Besides this, an intramural nodule was seen within the cyst. The nodule appeared as a well-defined round lesion at the floor of cyst which was fixed in its position in all the sections of imaging unlike haemorrhage which aligns itself on the dependent part of cyst. Nodule was hyperintense on T1 and hypointense on T2. Gross Total Endoscopic resection of the cyst was done. Follow up at 44 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion in imaging. However, the patient developed minimal subjective visual disturbances after surgery. Follow up examination however showed no gross deterioration in visual acuity and no papilledema. Figure no. 8-T1 (A) & T2 (B) weighted sagittal MR images showing intramural within the colloid cyst of third ventricle in patient I. It appears as well defined, round mass stuck to the floor of cyst. Nodule is hyperintense on T1 & hypointense on T2 weighted MRI suggesting much higher protein content and viscosity than the cyst. Discussion Contrast enhancement is more a feature of inflammatory and malignant lesions. It is rarely seen in benign tumours like colloid cyst. Only 8.51% (4) of cysts in our study showed peripheral contrast enhancement. Good clinical outcome (in terms of symtomatology improvement) was present in 100%, while good radiological outcome (in terms of residual lesion) was obtained in 75% (3 out of 4) of patients. Patients having cysts without contrast enhancement had successful radiological outcome in 76.74% (33 out of 43) of patients (p value 0.93). A study by Neva coce 15 et al in 2011 claims that cysts larger than 3 cm are extremely rare and intracystic hemorrhage in giant colloid cysts have only been reported in 3 cases till date. Good radiological oucome was achieved in 66.67% (2 out of 3) patients having cyst size >30mm as compared to 77.27% (34 out of 44) patients with cyst size <30mm, however the difference was statistically insignificant (p value- 0.56). Diyora et al 16 in 2013 found only six cases of hemorrhagic colloid cysts on literature review. One case was 35 yr female who presented with sudden neurological deterioration one day prior to emergency ventriculostomy and endoscopic subtotal resection of cyst (because of acute hemorrhage within the cyst). Other was of 9 yr female child presenting with headache, nausea and sudden deterioration in mental status who underwent emergency ventriculostomy, craniotomy and resection of cyst. Rest of 4 were post mortem proven cases. He later on reported a case of 20 yr female with a 6 months history of progressive headache, nausea, memory disturbances, seizures, gait disturbances,b/l papilledema and positive babinski sign who underwent transcallosal resection.On CT cyst was isodense, on T1 it was hyperintense and on T2 weighted MR it was hypointense. Cyst showed intracystic hemorrhage no contrast enhancement (table no.3). Follow up revealed complete resolution of seizures and memory function. Tamura et al 17 in 2013 reported a case of 43 yr male with sudden onset headache (already diagnosed having small colloid cyst 6 yrs back without ventriculomegaly). Fresh NCCT showed hyperdense mass in 3 rd ventricle with bilateral IVH and ventriculomegaly.MRI showed hemorrhagic cystic lesion which was hyperintense on T1 and hypointense on T2 with no contrast enhacement. Endoscopic subtotal resection was achieved (because of highly viscous cyst contents with very thick capsule) with successful clinical outcome (table no.3). Study Diyora et al 2013 Our study Tamura et al 2013 Our study Age in years 20 38 43 50 Approach Microsurgery Microsurgery Endoscopy Endoscopy NCCT head density Isodense Hyperdense Hyperdense Hyperdense T1 MRI intensity Hyperintense Hyperintense Hyperintense Hypointense T2 MRI intensity Hypointense Hypointense Hypointense Hyperintense Contrast enhancement Absent Absent Absent Absent Table no. 3- showing comparison of relevent variables between 3 studies. These rare findings which we have described rarely affected the radiological outcome. Our study highlights these sparsely scattered findings of this rare tumour. Conclusion Colloid cyst is an uncommon tumour with incidence as low as 3 per million per year 1 . Most of the studies conducted in literature either compare the surgical techniques or clinical outcome. Radiological outcome has been given little limelight and rare radiological findings not at all. We thoroughly studied these atypical findings and concluded that these findings do not alter clinicoradiological outcome but may present a diagnostic challenge for the neuroradiologists. Hope this study will help them to overcome the diagnostic dilemmas of this infrequent tumour with variable uncommon radiological presentations. Declarations Conflict of interest statement- Conflict of Interest: None. Disclosure of funding statement- Disclosure of Funding: None. Availability of data and materials- Data can be accessed from record section of the institute. Ethical Approval-The study was approved by ethics committee of institute. Data was gathered from the case sheets of patients containing preoperative clinical details, intraoperative surgical details and necessary postoperative details. Even after giving consent, subjects had the right to opt out from study at any point of time. Great care was taken about the patient privacy and information obtained in course of study, including personal identity was kept strictly confidential. Great caution was exercised to ensure that the subjects were not exposed to any added risk of suffering any harm, irreversible adverse effect while being part of the study. Consent-A written informed consent was taken from each patient parents/legal guardian before including in study population. Those not giving consent were excluded. References Hernesniemi J, Leivo S. Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcortical microsurgery. Surg Neurol. 1996;45(1):2–14. Lawrence JE, Nadarajah R, Treger TD, et al. Neuropsychiatric manifestations of colloid cysts: a review of literature. Psychiatry Danub. 2015;27(Suppl 1):S315-20. Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology. 2006;239(3):650–64. Waggenspack GA, Guinto FC. MR and CT of masses of the anterosuperior third ventricle. AJR Am J Roentgenol. 1989;152(3):609–14. Kornienko VN, Pronin IN. Diagnostic Neuroradiology. Springer Verlag; 2008:464–5. Bigner DD, McLendon RE, Bruner JM. Russell and Rubinstein's Pathology of Tumors of the Nervous System. 6th ed. London: Hodder Headline Group; 1998:338–342. Zulch KJ. Brain Tumors, Their Biology and Pathology. 3rd ed. Berlin: Springer-Verlag; 1986:519. MacDonald RL, Humphreys RP, Rutka JT, Kestle JRW. Colloid cysts in children. Pediatr Neurosurg. 1994;20(3):169–177. Demirci S, Dogan KH, Erkol Z, et al. Sudden death due to a colloid cyst of the third ventricle: report of three cases with a special sign at autopsy. Forensic Sci Int. 2009;189(1–3):E33-6. Symss NP, Ramamurthi R. Colloid cyst of third ventricle. In: Textbook of Contemporary Neurosurgery by Vincent A Thamburaj. 2012:80:1141-9. Maeder PP, Holtas SL, Basibuyuk LN, et al. Colloid cysts of the third ventricle: correlation of MR and CT findings with histology and chemical analysis. AJNR Am J Neuroradiol. 1990;11(3):575–81. Bergsneider M. Complete microsurgical resection of colloid cysts with a dual port endoscopic technique. Neurosurgery. 2007;60(4):613–18. Armao D, Castillo M, Chen H, et al. Colloid cyst of the third ventricle: imaging-pathologic correlation. AJNR Am J Neuroradiol. 2000;21(8):1470–7. El Khoury C, Brugières P, Decq P, et al. Colloid cysts of the third ventricle: Are MR imaging patterns predictive of difficulty with percutaneous treatment? AJNR Am J Neuroradiol. 2000;21(3):489–92. Coce N, et al. Large Hemorrhagic Colloid Cyst in a 35-Year-Old Male. Turkish Neurosurgery. 2012;22(6):783–784. Diyora B, Nayak N, Kukreja S, et al. Hemorrhagic colloid cyst: Case report and review of the literature. Asian J Neurosurg. 2013;8(3):162. doi: 10.4103/1793-5482.121689 Tamura Y, Uesugi T, Tucker A, et al. Hemorrhagic colloid cyst with intraventricular extension. J Neurosurg. 2013;118(3):498–501. doi: 10.3171/2012.10.JNS12793 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-3827084","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":265239976,"identity":"fe4432c7-c5b7-410f-b6ad-2bdf02d8c05c","order_by":0,"name":"Rajat Verma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIie3PsWrDMBCAYYmD8+Li1YHSvoK9dMyLdAqGbNoNTVOZgLuke4YQv0K6eOogI5AWQ9caL4bSTH2AFDLUCuno2GMh+gfdDfcNIsRm+8cBIZTLQ2xW4AMJQtK4pVnpMEIIOovgKjVbDwn0y9f2523seFmS+qPN47333JJ9nHeTUt9Vy10EvqKpH+aarSTldFnWnWS0muKHKwCIIZNcMd4SoOkZku2wOognuDWkWCuW9RHPR6xdISFQdBEmfMa2vcSdYn0tNIRqknwSJdhrS4pzf0FHYfUtHqIbqRtJZnO2eZdFs4+7yV/RacrjK3rv28anOR9ybLPZbBfWL0CXXW0bnEzLAAAAAElFTkSuQmCC","orcid":"","institution":"King George's Medical University","correspondingAuthor":true,"prefix":"","firstName":"Rajat","middleName":"","lastName":"Verma","suffix":""}],"badges":[],"createdAt":"2024-01-01 08:14:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3827084/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3827084/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49326159,"identity":"9c975c42-d70b-4f65-9030-4ae1d7d31fe7","added_by":"auto","created_at":"2024-01-08 17:30:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":515172,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 weighted precontrast sagittal(A), postcontrast axial (B) \u0026amp; T2 weighted axial (C) MR images of colloid cyst (arrows) of third ventricle of patient A.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/f3d4575876a2f8c27ed10e47.jpeg"},{"id":49327370,"identity":"9c24a7d5-91a7-45e6-bb85-e321b8a91dd6","added_by":"auto","created_at":"2024-01-08 17:38:37","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":545132,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 weighted precontrast (A), postcontrast (B) \u0026amp; T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient B.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/7dd9bb424d89d5097f393193.jpeg"},{"id":49327371,"identity":"b38417bd-fc17-4e3d-ad7c-6e68b673be27","added_by":"auto","created_at":"2024-01-08 17:38:37","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":540521,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 weighted precontrast (A), postcontrast (B) \u0026amp; T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient C.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/4d9c0bbe8e83871975ed9d36.jpeg"},{"id":49325157,"identity":"0af9dbde-bad8-4eee-a19b-33d215f1f77c","added_by":"auto","created_at":"2024-01-08 17:22:37","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":540823,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 weighted precontrast (A), postcontrast (B) \u0026amp; T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient D.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/4e64b4b02610646f05717588.jpeg"},{"id":49325160,"identity":"2fae5439-2a59-46b0-9e18-8fc9d34e1390","added_by":"auto","created_at":"2024-01-08 17:22:37","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":376557,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 weighted axial (A), coronal (B) \u0026amp; T2 weighted sagittal (C) MR images of giant colloid cyst (arrows) of third ventricle (maximum diameter 57mm.) in patient E.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/838b47686e32a4b7cbe90216.jpeg"},{"id":49325161,"identity":"30515cbd-e63a-4395-add8-07a37d81c1a7","added_by":"auto","created_at":"2024-01-08 17:22:37","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":402721,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 weighted sagittal (A) \u0026amp; T2 weighted axial(B) MR images showing intracystic hemorrhage within the giant colloid cyst (arrows) of third ventricle in patient G. Follow up T1 weighted axial MR image (C) showing residual lesion in same patient.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/cd84aa6f1e2044ef946d046e.jpeg"},{"id":49326161,"identity":"7362d0f8-21ff-4a21-a242-adadf0e359e8","added_by":"auto","created_at":"2024-01-08 17:30:37","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":370745,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 (A) \u0026amp; T2 (B) weighted sagittal MR images showing hemorrhage (arrows) within the colloid cyst of third ventricle in patient H. Note that the blood is hyperintense on T1 and hypointense on T2 suggesting early subacute period (4-7 days) after bleeding event. Blood is aligned more towards the posterior wall than the floor of cyst (dependent part in supine position).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/34e9b36673c9d02d36a80337.jpeg"},{"id":49325164,"identity":"8bf4dcdf-5388-468d-b9b4-968647d98181","added_by":"auto","created_at":"2024-01-08 17:22:37","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":461797,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eT1 (A) \u0026amp; T2 (B) weighted sagittal MR images showing intramural within the colloid cyst of third ventricle in patient I. It appears as well defined, round mass stuck to the floor of cyst. Nodule is hyperintense on T1 \u0026amp; hypointense on T2 weighted MRI suggesting much higher protein content and viscosity than the cyst.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/6ec8a6789ca441c20bae3a6b.jpeg"},{"id":100563440,"identity":"df863294-63ab-4eb3-bb48-4bb396c1dc79","added_by":"auto","created_at":"2026-01-19 08:46:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5709429,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3827084/v1/10454a5f-9635-4485-82b7-c3767ab0c42d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"“Atypical Radiological Findings In Colloid Cyst Of Third Ventricle- Rare Findings In Rare Tumour”","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColloid cyst is a benign, epithelial lined, mucin containing cyst usually located in anterosuperior part of third ventricle roof just posterior to foramen of Monro.\u0026nbsp;They are rare intracranial masses occurring in 3 individuals per million per year.\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eThey constitute around 2% (range 0.5 to 3%)\u003csup\u003e3-5\u0026nbsp;\u003c/sup\u003eof all primary brain tumours and 15 to 20%\u003csup\u003e2-5\u003c/sup\u003e of all intraventricular masses. 80% of colloid cyst are found in 30-60 years age\u003csup\u003e2\u003c/sup\u003e, most of them are identified in middle age (30-50 years)\u003csup\u003e6\u003c/sup\u003e although 8%\u003csup\u003e5\u003c/sup\u003e are identified in paediatric age group. It is rare in infancy \u0026amp; childhood.\u003csup\u003e7\u0026nbsp;\u003c/sup\u003eTill 1994 only 37 cases were described.\u003csup\u003e8\u003c/sup\u003eIt is either discovered in asymptomatic patients as incidental finding on imaging or presents with features of raised intracranial pressure in symptomatic patients. Rarely they have been reported to cause sudden death\u003csup\u003e9\u003c/sup\u003e.\u0026nbsp;They are usually 1-3 cm in size. Giant colloid cysts (\u0026gt;3cm) are rare findings. Mixed array of goblet and epithelial cells which lines the colloid cyst secretes the proteinaceous mucinous material which determines the imaging characters of cyst. In addition, cyst cavities may contain blood degradation products and cholesterol crystals. The fibrous walls are lined by simple or pseudostratified epithelial cells (which may be flattened cuboidal or low columnar) which rests on a thin capsule of collagen and fibroblasts.\u003csup\u003e10\u003c/sup\u003eRarely the cyst wall thickened, vascular and consists of organized hematoma of varying ages. Contents of cyst are most commonly greenish and of variable viscosity. On all modalities, colloid cyst appears as rounded, well demarcated lesion at FOM ranging from few millimetres to 3-4 cm.\u003csup\u003e5\u0026nbsp;\u003c/sup\u003eMRI is superior to CT in fully characterizing the lesion. On CT scan they appear as well delineated, rounded lesion on roof of 3\u003csup\u003erd\u003c/sup\u003e ventricle usually unilocular and hyperdense. Isodense \u0026amp; hypodense cysts are uncommon.\u003csup\u003e4\u0026nbsp;\u003c/sup\u003eOn MRI\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ecolloid cyst usually appears hyperintense on T1 and isointense on T2 with peripheral rim enhancement in some cases. On T1 weighted sequences they appear variable\u003csup\u003e11\u0026nbsp;\u003c/sup\u003ewith 50% high signal.\u003csup\u003e12\u0026nbsp;\u003c/sup\u003eThe rest are hypointense or isointense to adjacent brain. On Gadolinium enhanced T1, they rarely demonstrates thin rim enhancement, but usually this represents enhancement of adjacent and stretched septal veins.\u003csup\u003e5\u0026nbsp;\u003c/sup\u003eOn T2 sequences they appear variable\u003csup\u003e11\u003c/sup\u003e, with mostly low T2/T2* signal(short T2), related to thick \u0026ldquo;motoroil\u0026rdquo; consistency fluid.\u003csup\u003e13,14\u0026nbsp;\u003c/sup\u003eSome have low central T2 \u0026amp; high peripheral T2 signal.\u003csup\u003e13\u003c/sup\u003e Ventricle size, presence of cavum septum pellucidum et vergae, any abnormal vascular structure (DVA) \u0026amp; location of internal cerebral veins are other important findings gathered from MRI. Haemorrhage within cyst and intramural nodule are uncommon. We describe four cases of peripheral contrast enhancement, three cases of giant colloid cysts, two cases of intacystic haemorrhage and one case of intramural nodule in our study.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e47 patients diagnosed \u0026amp; operated for colloid cyst of 3\u003csup\u003erd\u003c/sup\u003e ventricle in last 10 years in Department of Neurosurgery, PGIMER Chandigarh were included in the study group. Subjects were explained regarding the study and were included in the study only after taking the informed written consent. Pre-operative data and intraoperative details were retrieved from patient case sheets and was double checked with patient history. 31 patients were operated endoscopically while 16 underwent microsurgery. The mean age of study population was 32.23\u0026plusmn;10.22yrs. Patients were evaluated after a minimum follow up period of 6 months on outpatient basis with questionnaires regarding symptomatology and quality of life. Pre \u0026amp; post operative imaging were studied in detail. Radiological outcome of surgery was analyzed by comparing pre and post op imagings. Total 9 patients out of 47 had atypical radiological findings in their imaging.4 patients showed peripheral contrast enhancement in CE MRI, 3 patients had cyst size more than 3 cm, 2 patients showed hemorrhage within colloid cyst and 1 showed intrmural nodule.1 giant cyst showed intacystic hemorrhage.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOnly 4 out of 47 patients showed peripheral contrast enhancement (table no. 1). This suggests that colloid cyst usually do not show contrast uptake, moreover presence of only peripheral uptake may be due to capsule vascularity and most of times confused with stretched septal veins. All 4 patients were males.\u003c/p\u003e\n\u003ctable width=\"599\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient name\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eApproach \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eEndoscopy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eEndoscopy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eMicrosurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eMicrosurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eNCCT head density\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eIsodense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eT1 MRI intensity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eIsointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eIsointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eIsointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eT2 MRI intensity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eCyst size (mm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eFollow up (months)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eVentriculomegaly (post op)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eResidual lesion\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003ePresent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eOT time (mins)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e180\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e240\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eHospital stay (days)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable no. 1- showing comparison of relevent variables between 4 patients showing peripheral contrast enhancement.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient A, 29 yr. male presented with complains of headache, nausea \u0026amp; vomiting. Papilledema was present on examination. On imaging cyst was hyperdense on CT, isointense on T1 and hyperintense on T2 weighted MRI (Figure no. 1). Cyst size was 15mm. and ventriculomegaly was present. Gross Total Endoscopic resection of the cyst was done. Follow up at 20 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 1- T1 weighted precontrast sagittal(A), postcontrast axial (B) \u0026amp; T2 weighted axial (C) MR images of colloid cyst (arrows) of third ventricle of patient A.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient B, 50 yr. male presented with complains of headache, cognitive defects, gait disturbances \u0026amp; altered sensorium. Papilledema was present. On imaging cyst was hyperdense on CT, isointense on T1 and hyperintense on T2 weighted MRI (Figure no. 2). Cyst size was 28mm. and ventriculomegaly was present. Subtotal endoscopic resection of the cyst was done. Follow up at 36 months showed complete resolution of all symptoms without any ventriculomegaly but residual lesion was present.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 2- T1 weighted precontrast (A), postcontrast (B) \u0026amp; T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient B.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient C, 33 yr. male presented with complains of headache, nausea \u0026amp; vomiting. On imaging cyst was hyperdense on CT, isointense on T1 and hyperintense on T2 weighted MRI (Figure no. 3). Cyst size was 10mm. and ventriculomegaly was present. Gross Total Microsurgical resection of the cyst was done. Follow up at 11 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 3- T1 weighted precontrast (A), postcontrast (B) \u0026amp; T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient C.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient D, 33 yr. male presented with complains of headache, nausea, vomiting, cognitive defects, gait disturbances \u0026amp; altered sensorium. Papilledema was present. On imaging cyst was isodense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 4). Cyst size was 22mm. and ventriculomegaly was present. Patient required VP shunt before surgery to relieve hydrocephalus. Gross Total Microsurgical resection of the cyst was done. Follow up at 32 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 4- T1 weighted precontrast (A), postcontrast (B) \u0026amp; T2 weighted (C) axial MR images of colloid cyst (arrows) of third ventricle of patient D.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3 out of 47 (table no. 2) patients had giant colloid cysts (cyst diameter \u0026gt;30 mm.)\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ctable width=\"462\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient name\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eApproach \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eEndoscopy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eEndoscopy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMicrosurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eNCCT head density\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eHypodense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eT1 MRI intensity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eT2 MRI intensity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eCyst size (mm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eFollow up (months)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eVentriculomegaly (post op)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eResidual lesion\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003ePresent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eOT time (mins)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e180\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e300\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eHospital stay (days)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable no. 2- showing comparison of relevent variables between 3 giant cyst patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient E, 12 yr. male presented with complains of headache, nausea, vomiting. Bilateral papilledema was present on eye examination. On imaging cyst was hyperdense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 5). Cyst size was 57mm. and ventriculomegaly was present. Gross Total Endoscopic resection of the cyst was done. Follow up at 36 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 5-T1 weighted axial (A), coronal (B) \u0026amp; T2 weighted sagittal (C) MR images of giant colloid cyst (arrows) of third ventricle (maximum diameter 57mm.) in patient E.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient F, 26 yr. male presented with complains of headache and visual disturbances. Bilateral papilledema was present on eye examination. Visual acuity was FC2 in both eyes. Planter reflex was absent. On imaging cyst was hypodense on CT, hypointense on T1 and hyperintense on T2 weighted MRI. Cyst size was 35mm. and ventriculomegaly was present. Endoscopic resection of the cyst was done. Follow up at 13 months showed complete resolution of all symptoms except visual disturbances. Papilledema was absent on follow up. Visual acuity was 6/9 in both eyes. Ventriculomegaly and residual lesion were absent on follow up imaging.\u003c/p\u003e\n\u003cp\u003eMr G, 38 yr. male presented with complains of headache, nausea, vomiting. Bilateral papilledema was present on eye examination. On imaging cyst was hyperdense on CT, hyperintense on T1 and hypointense on T2 weighted MRI (Figure no. 6). Cyst size was 32mm, intracystic haemorrhage \u0026amp; ventriculomegaly were present on MR imaging. Haemorrhage appeared bright on T1 and dark on T2 showing early subacute duration (4-7 days) after bleeding. Patient required VP shunt before surgery to relieve hydrocephalus. Microsurgical resection of the cyst was done. Follow up at 49 months showed complete resolution of most of the symptoms without any ventriculomegaly. Patient had poor cognitive outcome after surgery as he developed subjective memory disturbances after microsurgery. Objective assessment with PGIMER recent memory scale revealed a score of 5/5 but the patient subjectively complained of forgetting events of recent past. Residual lesion was present on follow up imaging.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 6-T1 weighted sagittal (A) \u0026amp; T2 weighted axial(B) MR images showing intracystic hemorrhage within the giant colloid cyst (arrows) of third ventricle in patient G. Follow up T1 weighted axial MR image (C) showing residual lesion in same patient.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient H, 50 yr. male presented with complains of headache, nausea and vomiting. Papilledema was present on fundus examination. On imaging cyst was hyperdense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 7). Blood within the cyst appeared as ill defined, heterogenous content within the cyst with variable intensity in different areas (due to the fact that different areas of clot are in different stages of degeneration) aligning towards the most dependent part of cyst (posterior wall in supine position). Haemorrhage present within the cyst was bright on T1 and dark on T2 showing early subacute phase of blood degeneration. Cyst size was 22mm. and ventriculomegaly was present. Endoscopic resection of the cyst was done. Follow up at 50 months showed complete resolution of all symptoms. Papilledema was absent on follow up. Ventriculomegaly and residual lesion were absent on follow up imaging.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 7-T1 (A) \u0026amp; T2 (B) weighted sagittal MR images showing hemorrhage (arrows) within the colloid cyst of third ventricle in patient H. Note that the blood is hyperintense on T1 and hypointense on T2 suggesting early subacute period (4-7 days) after bleeding event. Blood is aligned more towards the posterior wall than the floor of cyst (dependent part in supine position).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntramural nodule was found in a single patient I, 45 yr. male who presented with headache, nausea and vomiting. Papilledema was absent on fundus examination. On imaging cyst was hyperdense on CT, hypointense on T1 and hyperintense on T2 weighted MRI (Figure no. 8). Cyst size was 20mm. and ventriculomegaly was present. Besides this, an intramural nodule was seen within the cyst. The nodule appeared as a well-defined round lesion at the floor of cyst which was fixed in its position in all the sections of imaging unlike haemorrhage which aligns itself on the dependent part of cyst. Nodule was hyperintense on T1 and hypointense on T2. Gross Total Endoscopic resection of the cyst was done. Follow up at 44 months showed complete resolution of all symptoms without any ventriculomegaly and residual lesion in imaging. However, the patient developed minimal subjective visual disturbances after surgery. Follow up examination however showed no gross deterioration in visual acuity and no papilledema.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure no. 8-T1 (A) \u0026amp; T2 (B) weighted sagittal MR images showing intramural within the colloid cyst of third ventricle in patient I. It appears as well defined, round mass stuck to the floor of cyst. Nodule is hyperintense on T1 \u0026amp; hypointense on T2 weighted MRI suggesting much higher protein content and viscosity than the cyst.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eContrast\u0026nbsp; enhancement is more a feature of inflammatory and malignant lesions. It is rarely seen in benign tumours like colloid cyst. Only 8.51% (4) of cysts in our study showed peripheral contrast enhancement. Good clinical outcome (in terms of symtomatology improvement) was present in 100%, while good radiological outcome (in terms of residual lesion) was obtained in 75% (3 out of 4) of patients. Patients having cysts without contrast enhancement had successful radiological outcome in 76.74% (33 out of 43) of patients (p value 0.93).\u003c/p\u003e\n\u003cp\u003eA study by Neva coce\u003csup\u003e15\u003c/sup\u003e et al in 2011 claims that cysts larger than 3 cm are extremely rare and intracystic hemorrhage in giant colloid cysts have only been reported in 3 cases till date. Good radiological oucome was achieved in 66.67% (2 out of 3) patients having cyst size \u0026gt;30mm as compared to 77.27% (34 out of 44) patients with cyst size \u0026lt;30mm, however the difference was statistically insignificant (p value- 0.56).\u003c/p\u003e\n\u003cp\u003eDiyora et al\u003csup\u003e16\u003c/sup\u003e in 2013 found only six cases of hemorrhagic colloid cysts on literature review. One case was 35 yr female who presented with sudden neurological deterioration one day prior to emergency ventriculostomy and endoscopic subtotal resection of cyst (because of acute hemorrhage within the cyst). Other was of 9 yr female child presenting with headache, nausea and sudden deterioration in mental status who underwent emergency ventriculostomy, craniotomy and resection of cyst. Rest of 4 were post mortem proven cases. He later on reported a case of 20 yr female with a 6 months history of progressive headache, nausea, memory disturbances, seizures, gait disturbances,b/l papilledema and positive babinski sign who underwent transcallosal resection.On CT cyst was isodense, on T1 it was hyperintense and on T2 weighted MR it was hypointense. Cyst showed intracystic hemorrhage no contrast enhancement (table no.3). Follow up revealed complete resolution of seizures and memory function.\u003c/p\u003e\n\u003cp\u003eTamura et al\u003csup\u003e17\u003c/sup\u003e in 2013 reported a case of 43 yr male with sudden onset headache (already diagnosed having small colloid cyst 6 yrs back without ventriculomegaly). Fresh NCCT showed hyperdense mass in 3\u003csup\u003erd\u003c/sup\u003e ventricle with bilateral IVH and ventriculomegaly.MRI showed hemorrhagic cystic lesion which was hyperintense on T1 and hypointense on T2 with no contrast enhacement. Endoscopic subtotal resection was achieved (because of highly viscous cyst contents with very thick capsule) with successful clinical outcome (table no.3).\u003c/p\u003e\n\u003ctable width=\"605\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eStudy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiyora et al 2013\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eOur study\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eTamura et al 2013\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eOur study \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eApproach \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eMicrosurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eMicrosurgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eEndoscopy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eEndoscopy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eNCCT head density\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eIsodense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHyperdense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eT1 MRI intensity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eT2 MRI intensity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eHypointense\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eHyperintense\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eContrast enhancement\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eAbsent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable no. 3- showing comparison of relevent variables between 3 studies.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese rare findings which we have described rarely affected the radiological outcome. Our study highlights these sparsely scattered findings of this rare tumour.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eColloid cyst is an uncommon tumour with incidence as low as 3 per million per year\u003csup\u003e1\u003c/sup\u003e. Most of the studies conducted in literature either compare the surgical techniques or clinical outcome. Radiological outcome has been given little limelight and rare radiological findings not at all. We thoroughly studied these atypical findings and concluded that these findings do not alter clinicoradiological outcome but may present a diagnostic challenge for the neuroradiologists. Hope this study will help them to overcome the diagnostic dilemmas of this infrequent tumour with variable uncommon radiological presentations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConflict of interest statement- Conflict of Interest: None.\u003c/p\u003e\n\u003cp\u003eDisclosure of funding statement- Disclosure of Funding: None.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials- Data can be accessed from record section of the institute.\u003c/p\u003e\n\u003cp\u003eEthical Approval-The study was approved by ethics committee of institute. Data was gathered from the case sheets of patients containing preoperative clinical details, intraoperative surgical details and necessary postoperative details. Even after giving consent, subjects had the right to opt out from study at any point of time. Great care was taken about the patient privacy and information obtained in course of study, including personal identity was kept strictly confidential. Great caution was exercised to ensure that the subjects were not exposed to any added risk of suffering any harm, irreversible adverse effect while being part of the study.\u003c/p\u003e\n\u003cp\u003eConsent-A written informed consent was taken from each patient parents/legal guardian before including in study population. Those not giving consent were excluded.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHernesniemi J, Leivo S. Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcortical microsurgery. Surg Neurol. 1996;45(1):2\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawrence JE, Nadarajah R, Treger TD, et al. Neuropsychiatric manifestations of colloid cysts: a review of literature. Psychiatry Danub. 2015;27(Suppl 1):S315-20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology. 2006;239(3):650\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaggenspack GA, Guinto FC. MR and CT of masses of the anterosuperior third ventricle. AJR Am J Roentgenol. 1989;152(3):609\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKornienko VN, Pronin IN. Diagnostic Neuroradiology. Springer Verlag; 2008:464\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBigner DD, McLendon RE, Bruner JM. Russell and Rubinstein's Pathology of Tumors of the Nervous System. 6th ed. London: Hodder Headline Group; 1998:338\u0026ndash;342.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZulch KJ. Brain Tumors, Their Biology and Pathology. 3rd ed. Berlin: Springer-Verlag; 1986:519.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacDonald RL, Humphreys RP, Rutka JT, Kestle JRW. Colloid cysts in children. Pediatr Neurosurg. 1994;20(3):169\u0026ndash;177.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemirci S, Dogan KH, Erkol Z, et al. Sudden death due to a colloid cyst of the third ventricle: report of three cases with a special sign at autopsy. Forensic Sci Int. 2009;189(1\u0026ndash;3):E33-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSymss NP, Ramamurthi R. Colloid cyst of third ventricle. In: Textbook of Contemporary Neurosurgery by Vincent A Thamburaj. 2012:80:1141-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaeder PP, Holtas SL, Basibuyuk LN, et al. Colloid cysts of the third ventricle: correlation of MR and CT findings with histology and chemical analysis. AJNR Am J Neuroradiol. 1990;11(3):575\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergsneider M. Complete microsurgical resection of colloid cysts with a dual port endoscopic technique. Neurosurgery. 2007;60(4):613\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmao D, Castillo M, Chen H, et al. Colloid cyst of the third ventricle: imaging-pathologic correlation. AJNR Am J Neuroradiol. 2000;21(8):1470\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Khoury C, Brugi\u0026egrave;res P, Decq P, et al. Colloid cysts of the third ventricle: Are MR imaging patterns predictive of difficulty with percutaneous treatment? AJNR Am J Neuroradiol. 2000;21(3):489\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoce N, et al. Large Hemorrhagic Colloid Cyst in a 35-Year-Old Male. Turkish Neurosurgery. 2012;22(6):783\u0026ndash;784.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiyora B, Nayak N, Kukreja S, et al. Hemorrhagic colloid cyst: Case report and review of the literature. Asian J Neurosurg. 2013;8(3):162. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/1793-5482.121689\u003c/span\u003e\u003cspan address=\"10.4103/1793-5482.121689\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamura Y, Uesugi T, Tucker A, et al. Hemorrhagic colloid cyst with intraventricular extension. J Neurosurg. 2013;118(3):498\u0026ndash;501. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/2012.10.JNS12793\u003c/span\u003e\u003cspan address=\"10.3171/2012.10.JNS12793\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"","lastPublishedDoi":"10.21203/rs.3.rs-3827084/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3827084/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e-Colloid cysts are rare intracranial tumours occurring in 3 individuals per million per year. They constitute around 2% (range 0.5 to 3%)3-5 of all primary brain tumours.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e- We retrospectively studied the imaging of 47 patients of colloid cyst of third ventricle who were admitted in PGIMER, Chandigarh in last 10 years for surgical excision. Of them 31 underwent endoscopic excision while 16 went microsurgical excision. Preoperative NCCT head and MR imaging of all patients were studied.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults-\u003c/strong\u003eAnalysis revealed that in 91.5% cases cyst size was between 1 to 3 cm with mean cyst diameter of 17.55±8.32mm. We encountered 3 giant cysts (\u0026gt;3 cm) in our study. On NCCT head, cyst was hyperdense in 85.11% of cases, hypodense in 4.25% of cases and isodense in 10.64%. On T1 weighted MRI sequences, 42.55% of cysts were hyperintense, 31.92% were hypointense, while 25.53% were isointense. On T2 weighted sequences 57.45% of cysts were hyperintense, 38.30% were hypointense while 4.25% were isointense. Peripheral contrast enhancement was present in 8.51% of cysts. Two cysts showed intracystic haemorrhage, out of which one was giant cyst and one showed intramural nodule.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion-\u003c/strong\u003eThis article describes case studies of patients with atypical findings in imaging like giant colloid cysts, peripheral contrast enhancement, intracystic haemorrhage \u0026amp; intramural nodule.\u003c/p\u003e","manuscriptTitle":"“Atypical Radiological Findings In Colloid Cyst Of Third Ventricle- Rare Findings In Rare Tumour”","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-08 17:22:32","doi":"10.21203/rs.3.rs-3827084/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":"f4e0bb7a-8f07-4883-aca5-214643d45237","owner":[],"postedDate":"January 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T08:44:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-08 17:22:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3827084","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3827084","identity":"rs-3827084","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}