STORY BYAs the head coach and proud father, Bruce Perry wasn’t about to let a headache get in the way of his 8-year-old son’s all-star baseball games.
The Orange Pintos’ hard work had paid off, and the Little League team was on its way to the regionals. As Perry, age 32, stood near first base clutching his head in excruciating pain, he made a choice to tough it out.
It was just another migraine, he thought. The husband and father of two would soon learn that the pain was caused by a colloid cyst in the left ventricle of his brain. It wasn’t cancerous, but it was life-threatening, and if it wasn’t treated quickly, there was a chance Perry wouldn’t live to coach his son’s next game.
An estimated one in 8,500 people develop a colloid cyst, which can cause a blockage of cerebrospinal fluid, resulting in headaches, decreased memory, behavioral changes, dizziness, blindness and, in 10 percent of cases, death.
“The colloid cyst sits in a strategic location,” explains Aaron Mohanty, M.D., assistant professor in the Department of Neurosurgery at The University of Texas Medical School at Houston. “We don’t know why it happens, but when it does, the cyst often grows. The only way to treat it is to surgically remove it.”
Mohanty is among a select group of neurosurgeons in the United States who is specially trained to remove colloid cysts with the use of an endoscope.
This minimally-invasive surgery requires about a two-inch incision in the hairline of the patient’s forehead. The surgeon then makes a small hole in the skull and passes an endoscope, which is about the diameter of an ink pen, through the brain cortex. The instrument transmits light and powerful, magnified camera images of the cyst to a monitor so the neurosurgeon can clearly see the mass that needs to be removed.
The colloid cyst as seen through endoscope.
Mohanty, who has a decade of experience with neuroendoscopic procedures, uses forceps to grasp the cyst. Then he gently dissects it, cauterizes and removes the cyst piece by piece. The procedure, which he offers at Memorial Hermann Hospital, takes about an hour.
The conventional approach for removing colloid cysts is through a craniotomy, an open procedure that requires the removal of a portion of the skull. Mohanty says the endoscopic surgery appears to be as effective as the craniotomy in completely removing colloid cysts. Plus it requires less time, reduces the risk of damaging important brain structures and allows for a speedier recovery.
If the consistency of the cyst is too thick, Mohanty says, a craniotomy may be necessary to remove the mass, but most colloid cysts can be taken out with the use of an endoscope.
Dennis Vollmer, M.D., chairman of the Department of Neurosurgery, says neuroendoscopy offers an excellent, minimally-invasive option for numerous brain conditions.
“In addition to the removal of a colloid cyst, neuroendoscopy has promise for treating certain forms of hydrocephalus and for biopsy of some difficult-to-reach areas,” Vollmer says. “Subspecialist neurosurgeons like Dr. Mohanty are continuously working to expand the usefulness of the technique.”
Perry says the endoscopic surgery provided him immediate relief. When he awoke from surgery, his headache was gone. The only signs of his brain surgery were a short buzz hair cut, six stitches and a small, white bandage near his forehead.
Mohanty instructed Perry not to drive for a week. Otherwise, he could get back out on the baseball diamond and coach his son’s all-star team to the state championship finals.
Before the surgery, Perry was experiencing painful headaches. He was falling down and passing out, and the right side of his body occasionally would go numb. This went on for weeks.
His only reprieve from the pain was when he could lie down and sleep – sometimes for days at a time. Mohanty says that is a classic sign of a colloid cyst. The cyst can move around inside the brain and act as a valve, allowing cerebrospinal fluid to flow through the ventricles when the head is in certain positions and creating a blockage when the head is moved. This buildup of fluid can result in hydrocephalus, a condition that causes increased pressure on the brain, which contributes to the headaches and other symptoms.
Anyone who has lengthy bouts of headaches that come and go depending on the position of the head and isn’t responding to headache medications needs to see a doctor, Mohanty says.
“If it’s a colloid cyst, once you have symptoms, you need surgery,” Mohanty says. “It can’t wait.”
Perry’s wife, Angie, echoed Mohanty’s instructions. “Little things like this need to be checked out,” she says. “If you are having problems, you need to go to the doctor. Don’t wait. If we had waited any longer, we may have been planning a funeral.”
Mohanty says the chance of the cyst recurring is small, but he recommends that patients have routine checkups to make sure the third ventricle remains free of a mucous-filled mass.
Perry feels he has been given a second chance at life and says he’ll follow the doctor’s orders. “In six weeks, I’ll have an MRI to check the ventricles. Then I’ll come back once a year to have the doctor make sure everything is OK.”
“This has been a blessing,” he adds.
UPDATED: 8-29-2005
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Dr. Aaron Mohanty is an assistant professor in the Department of Neurosurgery at the UT Medical School.
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