Magnetic Resonance Venography–Based Anterior Interhemispheric Transcallosal-Transforaminal Approach to Colloid Cysts of the Third Ventricle

BACKGROUND AND OBJECTIVES: This study highlights the significance of magnetic resonance (MR) venography in guiding surgical planning for the anterior interhemispheric transcallosal-transforaminal (AITT) approach to colloid cysts of the third ventricle. METHODS: We report a series of 32 patients who underwent the AITT approach for third ventricle colloid cysts. Demographic, clinical, neuroimaging, MR venography, surgical, and outcome data were collected prospectively and analyzed retrospectively. Preoperative planning relied particularly on time-of-flight MR venography to assess the patient's specific anatomy of the superficial and deep venous system. This tailored approach determined the site of the craniotomy in relation to the coronal suture and the access side to the ventricle based on the angle of the anterior septal and thalamostriate veins at the foramen of Monro. RESULTS: The colloid cyst was completely resected in all 32 patients without complications. The average patient age was 40 years, with headaches being the most frequent symptom (56.2%). MR venography played a pivotal role in identifying favorable superficial and deep venous patterns, leading to a tailored craniotomy, a good angle for the callosotomy (average: 83°), and selection of the ventricular side. An inverse correlation was found between the callosotomy angle and size, reducing the need for a larger callosal opening. All patients returned to their professional activities without neuropsychological deficits, and no recurrences were observed over an average follow-up of 112 ± 68 months. CONCLUSION: A comprehensive MR venography-guided AITT approach is essential for the craniotomy and selecting the ventricular access side, ensuring less traumatic and complete resection of colloid cysts while minimizing the risk of complications. This strategy consistently yielded good patient outcomes, no recurrences, and a rapid return to educational or professional activities.