Oculomotor Nerve Palsy Complicates Third Ventricle Colloid Cyst Endoscopic Removal: Case Report

World Neurosurg. 2016 Jun:90:700.e13-700.e17. doi: 10.1016/j.wneu.2016.02.038. Epub 2016 Feb 17.

Abstract

Background: A colloid cyst is a rare benign tumor. If indicated, surgical treatment can be realized using a microsurgical technique or an endoscopic technique. We report an uncommon complication of a third ventricle colloid cyst endoscopic removal.

Case description: The cyst was incidentally discovered on computed tomography scan workup for mild head trauma in a 20-year-old male. Minor headache and minor memory loss were noted on clinical examination. Magnetic resonance imaging workup revealed obstructive hydrocephaly of the lateral ventricles associated with left uncal herniation. Surgery was uneventful. However, left oculomotor palsy was noted postoperatively. Workup revealed oculomotor nerve injury and isolated left mammillary body ischemia, secondary to worsened uncal herniation. This worsening might be caused by acute left ventricle hydrocephaly ascribed to interventricular foramen obstruction during cyst removal.

Conclusion: Therefore, in similar presentation, realizing septum fenestration before cyst removal should relieve the pressure in the lateral ventricles thus decreasing the risk of herniation.

Keywords: Colloid cyst; Endoscopy; Mammillary body and complication; Oculomotor nerve; Third ventricle; Uncal herniation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Colloid Cysts / complications
  • Colloid Cysts / pathology*
  • Colloid Cysts / surgery*
  • Humans
  • Male
  • Neuroendoscopy / adverse effects*
  • Oculomotor Nerve Diseases / etiology*
  • Oculomotor Nerve Diseases / pathology
  • Oculomotor Nerve Diseases / prevention & control*
  • Treatment Outcome

Supplementary concepts

  • Colloid cysts of third ventricle