Factors influencing outcome in patients with colloid cysts who present with acute neurological deterioration

Colloid cysts have been associated with acute neurologic deterioration and sudden death. However, the low incidence of associated sudden deaths has meant that factors influencing outcome in patients who present with acute neurological deterioration have not been extensively published. A PubMed literature search was performed to identify reported patients who presented with acute neurological deterioration with radiographic or histopathologic diagnosis of a colloid cyst. Demographic data, presenting symptoms, physical exam, surgical interventions, and outcomes were recorded. Analysis included 140 patients. Mean cyst size was 2.12 cm in males and 1.59 cm in females (p = 0.155), and 1.64 cm in patients who survived and 2.05 cm in patients who died (p = 0.04). Minimum cyst size was 0.4 cm in females and 0.8 cm in males. All patients without surgical intervention died, versus 48% with surgical intervention (p < 0.0001). Patient age was not significantly associated with outcome. Patients with hydrocephalus who have symptomatic colloid cysts are at extremely high risk for acute neurological deterioration and sudden death. Larger cyst size was associated with higher mortality, regardless of intervention. Prompt surgical intervention in extremis can lead to survival in approximately half the patients. Females, even with smaller cyst sizes, may be more likely to die before any intervention and may therefore benefit from more aggressive treatment approaches.