Emergency Resection of a Large Third Ventricle Colloid Cyst: Ipsilateral vs. Contralateral Interhemispheric Approach Based on the Hydrocephalus Status

Colloid cysts of the third ventricle are rare, benign intracranial tumors that can cause significant neurological symptoms and complications, particularly when they lead to obstructive hydrocephalus. The aim of this study is to present a case of a large third ventricle colloid cyst causing acute hydrocephalus and fainting attacks, necessitating emergency surgery. This is a case of a 46-year-old female presenting with headaches and recurrent fainting attacks. Cardiac evaluations were normal. Brain MRI revealed a 3x3 cm cystic lesion in the anterior superior portion of the third ventricle, causing moderate hydrocephalus with a transependymal edema. Due to acute hydrocephalus and fainting attacks attributed to arrhythmias from hypothalamic compression, emergency surgical resection was performed. A contralateral interhemispheric transcallosal approach with a right frontal craniotomy was used to achieve gross total resection. Postoperative recovery was uneventful, and a follow-up MRI showed an empty tumor bed and resolved hydrocephalus. In conclusion, prompt diagnosis and emergency surgical intervention are crucial in cases of acute hydrocephalus caused by third ventricle colloid cysts. The successful outcome of this emergency resection demonstrates the effectiveness of timely surgical management in preventing severe complications.