Surgical Management of Third Ventricular Colloid Cysts: The Fate of Open Microsurgery.

AIM: To report our experience with the outcomes of open microsurgical management of third ventricular colloid cysts. MATERIAL and METHODS: This retrospective study presents the surgical outcomes of 33 patients who underwent open microsurgical resection-either through the interhemispheric transcallosal or transcortical transventricular approach-for third ventricular colloid cysts between 2010 and 2023. RESULTS: The mean follow-up period was 41.57 months. All patients were symptomatic, and severe, intractable headache was the most common presenting symptom. No perioperative mortality or postoperative infection occurred. During follow-up, five patients (15.15%) developed shunt-dependent hydrocephalus, and eight (24.24%) developed seizures. At the last follow-up, seven of the eight patients were seizure-free and no longer required antiepileptic medication. Thirty-two patients (96.96%) had no recurrence, and in one patient with a small residual lesion, no progression was observed. CONCLUSION: Open microsurgery, whether via the interhemispheric transcallosal or transcortical transventricular approach, is safe and offers a high likelihood of total resection with low recurrence. Shunt-dependent hydrocephalus and postoperative seizures remain the most common complications, underscoring the need for long-term surveillance, particularly for late-onset seizures even after complete removal. Although endoscopic surgery is now widely adopted, our findings demonstrate that open microsurgery continues to be a reliable and durable option with favorable recurrence and complication profiles.