Matters arising Matters arising

manifestations of third ventricular coiloid cysts Sir: When reading Dr Robert Winer's com-ment on the interesting topic on the symp-tomatology of third ventricular colloid cysts, ' my attention was directed in particu-lar to the statement that "neurosurgical con-sultation was obtained with three different neurosurgeons, all of whom declined to pur-sue an operative course". It may be easy to understand the hesitancy to surgery, if only the traditional transventricular removal is considered. However, I would like to point out that stereotactic aspiration of colloid cysts is established therapy.2 The results af-ter this alternative approach are promising. The first case mentioned has now been followed for 16 years, without recurrent symptoms. The aspiration technique has been employed by others, with rewarding results reported in a significant number of patients.3 With regard to the innocent character of a colloid cyst in the third ventricle, a con-ventional transventricular removal may be too mutilating a procedure. Any experi-enced brain surgeon may recall frustrating episodes from such surgery, which no longer seems to be necessary. A common indication for surgical treatment has been signs of impaired CSF circulation, with ventricular dilatation. As a wider spectrum of the clinical picture has been elegantly described by Dr Winer as well as by Lobosky etal,5 more patients than those with ventricular dilatation should probably be candidates for surgery, especially as a less traumatic stereotactic aspiration technique is well established management