Endoscopic Treatment of Quadrigeminal Cistern Arachnoid Cysts

Abstract

Five patients with arachnoid cysts of the quadrigeminal cistern treated by endoscopic fenestration are reported and another eleven well-documented cases from the literature are reviewed. Among the five personal cases four were children and one was adult; the cyst fenestration was performed from the lateral ventricle in three cases and from the third ventricle in two. In four patients the endoscopic treatment resulted in clinical remission, whereas a two-month-old baby later required a shunt. The lateral ventricle-cystostomy and the third ventricle-cystostomy (according to the cyst extent) are the best endoscopic procedures, whereas the cyst fenestration through a suboccipital supracerebellar approach is no longer used. The rate of cured or improved patients after endoscopic surgery (14/16 or 87.5%) was rather similar to that of a group of twenty patients treated by traditional surgery (craniotomy and cyst excision and/or shunt) (85%). These data confirm that endoscopic fenestration of quadrigeminal cistern cysts must be performed as the first procedure because it is less invasive and avoids shunt dependency.

Neuroendoscopic Approach to Quadrigeminal Cistern Arachnoid Cysts

“…Failures of endoscopic fenestration, either alone or in combi- nation with third ventriculostomy, have been reported in the literature [3,14,21].…”

“…With the extent of the indications for ventricular endoscopy, the neuroendoscopic approach to quadrigeminal cysts has gained increasing acceptance. Several authors have reported cases [1,4,5,[9][10][11][12][15][16][17][18][19][20] or series [3,5,13] of neuroendoscopic quadrigeminal cyst treatment.…”

“…Because of certain anatomical and technical difficulties, this approach has never been preferred by other neurosurgeons. Lateral-ventriclecystostomy and third-ventriclecystostomy have been used in the remaining reported cases [3,5,13].…”

“…The quadrigeminal cistern is an unusual location for these cysts. Quadrigeminal arachnoid cysts (QAC)s account for 5% to 10% of all intracranial arachnoid cysts [1][2][3]. They are frequently diagnosed coincidentally on computed tomography (CT) or magnetic resonance imaging (MRI).…”

Multiple Meningeal Cysts Affecting the Whole Craniospinal Axis -Case Report-

“…Symptomatic arachnoid cysts located in the cerebellopontine angle and quadrigeminal cisterns are rare, and may manifest as trochlear nerve paresis, trigeminal neuralgia, hemifacial spasm, and normal pressure hydrocephalus. 1,4,6,9) Multiple intracranial arachnoid cysts located at different sites are extremely rare. Very few cases of asymptomatic multiple arachnoid cysts involving five different locations in the cranial cavity have been documented.…”