Nair, SMenon, GEaswer, HVAbraham, MVikas, VKrishnakumarGopalakrishnan, CVGeorge, VSudhir, J2017-03-102017-03-102012,;61-68https://dspace.sctimst.ac.in/handle/123456789/9488Aim: To analyze the clinical presentation, surgical outcome of 293 cases of colloid cysts surgically managed over a period of 32 years beginning January 1980 to September 2011. Methods: Age range was between 9 to 66 years. Raised ICP headache was the most common initial presenting symptom in 74% followed by visual blurring in 7%, memory disturbance in 5.3%, intermittent headaches in 7.6%, drop attacks, gait unsteadiness in 3.4% and incidental in five patients (2%). Imaging with CT scan done showed the cyst to be hyperdense in 69%, isodense in 28% and hypodense in 4% of patients. Shorter duration of symptoms correlated with MRI T2W hyperintensity changes. While an interhemispheric transcallosal approach was used in 271, it was trans-cortical in 22 (endoscope assisted in 6 & endoscopically in 2). Results: Out of the 271 patients operated through the transcallosal approach, the cyst was removed through transforaminal route in 226, interforniceal rote in 24, subchoroidal in 14 and suprachoroidal in seven. Twenty-two patients underwent emergency surgery. Twenty-eight patients had CSF diversionary procedure (14 patients referred with preoperative shunt done elsewhere and 14 required postoperative CSF diversions). Complications included impaired memory in 35, hemiplegia/ hemiparesis in 8 and seizures in twelve. There was an operative mortality of 1% (3 cases). Eight patients had symptomatic recurrence of which 6 had total excision at first surgery. Conclusions: These potentially life threatening lesions can be removed safely through the interhemispheric transcallosal approach. Periodic follow-up with MR imaging is necessary as recurrence can occur even after apparent total excision.Neurosciences & Neurology; Surgery