Domenico Policicchio, Riccardo Boccaletti, Filippo Veneziani Santonio, Giosué Dipellegrini
  1. Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy

Correspondence Address:
Domenico Policicchio, Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy.


Copyright: © 2023 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Domenico Policicchio, Riccardo Boccaletti, Filippo Veneziani Santonio, Giosué Dipellegrini. Trascallosal bilateral transforaminal resection of a solid partially calcified colloid cyst: 2D operative video. 07-Jul-2023;14:236

How to cite this URL: Domenico Policicchio, Riccardo Boccaletti, Filippo Veneziani Santonio, Giosué Dipellegrini. Trascallosal bilateral transforaminal resection of a solid partially calcified colloid cyst: 2D operative video. 07-Jul-2023;14:236. Available from:

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Background: Colloid cysts are benign lesions of the roof of the third ventricle, often diagnosed incidentally; sometimes they can cause hydrocephalus due to obstruction of the foramina of Monroe. Symptomatic cysts could be resected either microsurgically (transcallosal or transcortical) or endoscopically. Although both strategies are effective and have advantages and disadvantages, there is no consensus on the choice of the optimal approach. Transcallosal resection, although more invasive than endoscopy, allows adequate bimanual manipulation of the cyst and is associated with high rates of complete resection, the use of neuronavigator and intraoperative ultrasound optimizes surgical trajectory and improves safety of the procedure with complication rates comparable to endoscopy. Endoscopy is less invasive but complete resection of solid cysts can be challenging.

Case Description: In Video 1, we show resection of a solid partially calcified colloid cyst using a transcallosal bilateral transforaminal approach to anterior third ventricle male, 65 years old; headache and mild memory impairment for 6 months; admitted at our emergency department because of a brief loss of consciousness. Neurologic examination was normal. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a colloid cyst at the level of anterior third of the third ventricle (1.5 cm in diameter) with hypointense appearance in T2 sequences suggesting a solid calcific component. The ventricular system was enlarged. Colloid cyst risk score 3/5 (diameter >0.7 cm, headache, risk zone I) considered an intermediate-risk subgroup according to Alford et al. On this basis, we proposed the surgical treatment. We chose a transcallosal microsurgical resection. The patient gave consent for the procedure. A preoperative planning with a computer-generated 3D model is performed to simulate the approach. Craniotomy, interhemispheric dissection, and callosotomy were planned with the neuronavigator and with the aid of intraoperative ultrasound to optimize the trajectory and perform a limited and tailored callosotomy. The 1.5 cm callosotomy allows to approach both lateral ventricles, the cyst was progressively dissected working bilaterally through both foramina of Monroe without injuries of the fornices. Resection at term is complete. Postoperative MRI and CT scan confirmed complete excision without complications; the patient was discharged after a week in good neurological condition with complete regression of headache.

Conclusion: Microscopic transcallosal resection of the colloid cyst of the third ventricle allows for complete resection with low complication rates. The use of preoperative 3D planning and integrated neuronavigation with intraoperative ultrasound helps to reduce invasiveness.

Keywords: Colloid cyst, Microneurosurgery, Third ventricle tumor, Transcallosal approach

Video 1


1) 00:05 – Case presentation.

2) 00:15 – Preoperative neuroimaging (CT and MRI).

3) 00:50 – Decision-making.

4) 01:03 – Surgical planning and preoperative virtual simulation.

5) 01:28 – Interemispheric approach.

6) 01:44 – Callosotomy and bilateral approach to lateral ventricles.

7) 02:10 – Progressive dissection and resection (bilateral transforaminal route to third ventricle).

8) 04:25 – Third ventricle after resection.

9) 04:50 – Postoperative course.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Videos available on:


The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.


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