Background/Objectives: Third ventricle colloid cysts (TVCCs) are benign lesions that may cause acute hydrocephalus and, rarely, sudden death. Endoscopic resection has emerged as a minimally invasive alternative to microsurgical approaches. This systematic review aimed to evaluate the safety and efficacy of endoscopic resection of TVCCs. Methods: Following PRISMA guidelines, a systematic search of major databases was performed to identify studies reporting clinical outcomes of endoscopic resection of TVCCs. Extracted data included the surgical technique, extent of resection, complications, recurrence, and reoperations. Results: Thirty-four studies comprising 1123 patients were included. Gross total resection (GTR) was achieved in 767 patients (68.3%), with higher rates for the transforaminal (88.4%) and transeptal (86.9%) approaches (z = 0.309; p = 0.76). Capsule removal was performed in 87.4% and coagulation alone in 11.6%. Postoperative remnants occurred in 172 patients (17.1%). Recurrence was observed in 41 cases (3.7%) after a mean follow-up of 46.3 months, with 33 patients (2.9%) requiring reoperation. Preoperative hydrocephalus was present in 51% of cases. Septostomy and external ventricular drainage were performed in 15.7% and 15.5% of patients, respectively. Complications included memory deficits (3.6%), meningitis (3.6%), intraventricular hemorrhage (2.7%), ischemia (1.1%), shunt dependency (2.1%), and seizures (0.6%). Mortality occurred in eight patients (0.7%). Conclusions: Endoscopic management of TVCCs is associated with a low complication rate and favorable long-term outcomes. Capsule resection reduces the risk of recurrence and the need for reoperation.
Agosti et al. (2026) studied this question.