Colloid cysts posterior and anterior to the foramen of Monro: Anatomical features and implications for endoscopic excision

BACKGROUND: Colloid cysts are usually located at the rostral part of the third ventricle in proximity to the foramina of Monro. Some third ventricular colloid cysts, however, attain large sizes, reach a very high distance above the roof of the third ventricle, and pose some challenges during endoscopic excision. These features led to the speculation that for such a pattern of growth to take place, the points of origin of these cysts should be at areas away from the foramina of Monro at which some anatomical “windows” exist that are devoid of compact, closely apposed forniceal structures. METHODS: A review of the literature on anatomical variations of the structures in the vicinity of the roof of the third ventricle and on reported cases with similar features was conducted. RESULTS: Colloid cysts may grow vertically up past the roof of the third ventricle through anatomical windows devoid of the mechanical restraint of the forniceal structures. CONCLUSION: Some anatomical variations of the forniceal structures may allow unusually large sizes and superior vector of growth of a retro- or post-foraminal colloid cyst. Careful preoperative planning and knowledge of the pertinent pathoanatomy of these cysts before endoscopic excision is very important to avoid complications.