Endoscopic transventricular resection of third ventricular colloid cysts in a resource-limited academic setting: a prospective pilot case series

Abstract Background Colloid cysts of the third ventricle are rare lesions that can cause obstructive hydrocephalus and sudden neurological deterioration. Although endoscopic resection is now an established alternative to microsurgery, outcome data from resource-limited academic centers remain scarce. We report our early institutional experience with endoscopic transventricular resection of third ventricular colloid cysts through a standardized Kocher's point approach at a single Egyptian academic center. Methods In this prospective single-center pilot series, ten consecutive symptomatic patients with radiologically confirmed third ventricular colloid cysts and obstructive hydrocephalus underwent endoscopic transventricular resection between February 2023 and February 2026. Primary outcomes were symptom resolution and hydrocephalus regression at six months; secondary outcomes included extent of resection, operative time, hospital stay, complications, and shunt requirement. Results Mean age was 29.8 years (range 9–57), and mean cyst diameter was 20.0 mm. Gross total resection was achieved in nine patients (90%); one patient (10%) underwent intentional subtotal resection because of firm capsular adherence to the fornix, leaving an asymptomatic residual, and later required ventriculoperitoneal shunting for persistent hydrocephalus. Hydrocephalus resolved after cyst resection alone in the remaining nine patients. Mean operative time was 96.5 minutes, and mean hospital stay was 3.0 days (SD 0.8). Two patients developed a CSF leak that resolved with conservative management. At six months, all ten patients had complete symptom resolution, with no infection, hemorrhage, new neurological deficit, or recurrence. Conclusion In this small pilot series, endoscopic transventricular resection through Kocher's point provided reliable symptom relief and hydrocephalus control with an acceptable safety profile and short hospital stay. When the capsule adheres firmly to eloquent structures, subtotal resection is a reasonable trade-off favoring functional preservation, although it may carry a higher likelihood of persistent hydrocephalus requiring diversion. Larger multicenter studies with long-term follow-up and neuropsychological assessment are needed.