Revisiting the Endoscopic vs. Microscopic colloid cysts resection battle with emphasis on endoscope assisted technique.

Introduction: Colloid cysts are challenging regarding their location. Surgical resection remains the therapeutic option of choice for symptomatic cysts. However, choosing the optimal surgical approach is still a subject of debate. Research question: The aim of the study is to compare three surgical approaches; Pure endoscopic (PE), pure microscopic (PM) and endoscope assisted microsurgical (EA). Material and methods: Retrospective data extraction from our database was done and we included patients who underwent surgical resection for colloid cysts since 2008. Patients were categorized into three groups based on the forementioned surgical techniques. Outcome measures assessed included extent of resection (EOR), morbidity using modified Rankin Scale (mRS), hospital stay duration (HSD), and complications. Results: 41 patients met our inclusion criteria and were divided as follows; PM 13 patients (31.7%), PE 19 patients (46.3%) and EA with 9 patients (22.0%). Mean age (SD) was 37.4 ± 12.2. Male: Female is 1:1.05 and average follow-up was 3.9 ± 2.8 years. Gross total resection(GTR) reached 92.3% (12/13) using PM, 78.9% (15/19) with PE and 100% (9/9) under EA. Morbidity was 15.4%, 10.5% and 0% respectively (mRS >2). Hospital stay duration was significantly shorter in PE and EA (p = 0.012). Discussion and conclusion: EA excision of colloid cysts is safe and effective. When compared to PE and PM approaches, it can combine the advantages of both tools utilizing the microscope and endoscope to achieve a safe, gross total resection while minimizing hospitalization duration. The choice of surgical approach, however, should be individualized based on the cyst's location, size, and the surgeon's expertise and preference.