ORIGINAL RESEARCH article
Front. Surg.
Sec. Neurosurgery
This article is part of the Research TopicDoing More with Less: Neurosurgery Strategies and Tricks of the Trade in the Technological EraView all 13 articles
Quantitative MRI Comparison of Early and Late Parenchymal Injury After Transcallosal vs. Endoscopic Approaches for Third Ventricle Colloid Cysts
Provisionally accepted
Ufuk Erginoglu1
Laura Burns Eisenmenger2Walid Elshamy1Cagdas Ataoglu1Stephanie A Armstrong1Halli T Olsen1Umid Sulaimanov1Jordan Ross2Alexey Samsonov2Huseyin Erdem Ak1Abdurrahman Aycan1Abdullah Keles1Burak Ozaydin1
Mustafa Kemal Baskaya1*- 1University of Wisconsin, Madison Department of Neurological Surgery, Madison, United States
- 2University of Wisconsin, Madison Department of Radiology Madison, United States, Madison, United States
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Abstract Background The interhemispheric transcallosal (ITA) and endoscopic approaches (EA) are established treatments for third ventricle colloid cysts (TVCCs); however, their relative parenchymal impact and the progression of associated MRI changes from early to late postoperative stages remain undefined. Objective To compare early volumetric MRI findings after ITA and EA for TVCC resection and determine whether early parenchymal injury persisted on late imaging. Methods Twenty-three patients (ITA, 13; EA, 10) with early and late postoperative MRI were retrospectively reviewed. Early T2/FLAIR hyperintensity volumes were segmented along the surgical tract (burr-hole tract subtracted in EA). DWI/ADC imaging assessed diffusion restriction. Late MRI evaluated gliosis, encephalomalacia, and parenchymal loss. Statistical, correlation, and sensitivity analyses assessed associations while adjusting for cyst size and hydrocephalus. Results Early MRI hyperintensity volume was smaller after ITA than EA (349 ± 218 mm³ vs. 2952 ± 2084 mm³; p < 0.001). Diffusion restriction occurred in 7.7% of ITA and 50% of EA (p = 0.052). Gliosis, encephalomalacia, and parenchymal loss on late MRI were absent after ITA but present in 50% of EA cases (p = 0.007 each), with larger early volumes in EA associated with gliosis (p = 0.032), encephalomalacia, and parenchymal loss (p = 0.016 each). These associations persisted after adjusting for cyst size and hydrocephalus. Gross total resection occurred in 92% of ITA and 50% of EA cases (p = 0.039). Conclusions Compared with ITA, EA produced larger early parenchymal injury, half of which persisted as structural abnormalities on late imaging, indicating more persistent radiologic change.
Keywords: Brain Edema, Colloid cyst, Endoscopic approach, Interhemispheric approach, Parenchymal injury, Third Ventricle, Transcallosal approach
Received: 03 Sep 2025; Accepted: 12 Nov 2025.
Copyright: © 2025 Erginoglu, Eisenmenger, Elshamy, Ataoglu, Armstrong, Olsen, Sulaimanov, Ross, Samsonov, Ak, Aycan, Keles, Ozaydin and Baskaya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mustafa Kemal Baskaya, baskaya@neurosurgery.wisc.edu
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