Endoscopic Removal of Colloid Cysts

Only about 5%, not more than that. In our setup we have done more than 100 surgeries and have not had to redo any; some patients may have mild symptoms that can be managed with medicine or reassurance, but otherwise the results are good.

We do endoscopic third ventriculostomy in paediatric congenital hydrocephalus, but success is slightly lower at a young age — around 70-80%. A programmable shunt has a 95% success rate, but shunt revision and infection are other factors to weigh; endoscopic third ventriculostomy is a better choice when it succeeds, since the chances of recurrence problems afterward are very low.

We keep the patient for three or four days; the pain is usually gone right after surgery. We continue medication for one month afterward and then stop it. We mobilise the patient to walk from the next day, and they generally do very well. We do a post-operative CT scan to check for any bleeding or collection, but results are close to perfect.

The screws used in spine surgery are not absorbable — they remain in place lifelong. Financially, robotic-assisted spine surgery costs about $1,000 to $2,000 extra on top of a normal spine surgery of around $7,000, but the advantage is that screw misplacement drops to less than 1%, which is significant because a single misplaced screw can undermine the whole surgery — so while it adds cost, it also adds real value to the outcome.

Absolute contraindications include cardiac problems, any bleeding or coagulation disorders, or severe infection in the body. If a patient — for example with trigeminal neuralgia — is responding well to medication at a controllable dose, we will not operate; surgery is offered when the patient's pain is not relieved despite medical management.

A colloid cyst is a benign growth at the junction of the lateral and third ventricles that blocks the normal passage of cerebrospinal fluid, which can cause severe headache, fainting, and in some cases can be fatal if untreated.

Open microsurgical excision, which requires opening a larger portion of the skull and carries higher risk, or endoscopic surgery through a small bur hole with much less exposure.

An endoscope is passed through a small bur hole into the lateral ventricle, the thin septum pellucidum is opened to connect both lateral ventricles, and the cyst material is suctioned out with a catheter using careful traction to decompress the ventricles.