Neuroendoscopic Approach to Quadrigeminal Cistern Arachnoid Cysts

Abstract

Objective: The introduction of neuroendoscopy has provided a minimally invasive modality for the surgical treatment of quadrigeminal arachnoid cysts. Three pediatric patients with arachnoid cyst of the quadrigeminal cistern treated by endoscopic fenestration are reported. Materials and Methods:The hospital records of patients were retrospectively rewieved. All patients had hydrocephalus. A lateral ventricle-cystostomy and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes.Results: There were one boy and two girls with ages 7 months, 9 months and 14 years, respectively. One patient had undergone shunting prior to neuroendoscopic surgery. The postoperative course was uneventful in all cases, with no complications. They showed disappearance of intracranial hypertension symptoms and significant reduction of the cyst size. Conclusion:Neuroendoscopic technique is an effective and suitable method for the treatment of quadrigeminal cistern arachnoid cysts and accompanying hydrocephalus. Key Words: Arachnoid cyst, Neuroendoscopy, Quadrigeminal cistern ÖzetAmaç: Kuadrigeminal araknoid kistlerin cerrahi tedavisinde nöroen-doskopi uygulanması daha az invaziv bir girişim imkanı sağlamakta-dır. Bu yazıda endoskopik ağızlaştırma yöntemiyle tedavi edilen kuadrigeminal araknoid kisti olan üç çocuk olgu sunulmaktadır. Gereç ve Yöntem:Üç hastanın tıbbi kayıtları retrospektif olarak değerlendirildi. Hastaların hepsinin hidrosefalisi vardı. Rijit endoskop kullanılarak tüm hastalarda kist lateral ventrikül ile ağızlaştırıldı ve üçüncü ventrikülostomi yapıldı. Bulgular:Hastaların biri erkek, ikisi kız ve sırasıyla 7 aylık, 9 aylık ve 14 yaşındaydılar. Bir hastaya nöroendoskopik girişim uygulanmadan önce ventriküloperitoneal şant takılmıştı. Postoperatif hastaların hepsi komplikasyonsuz iyileşti. Artmış kafa içi basıncı bulguları dü-zeldi ve kist boyutu belirgin azaldı. Sonuç:Nöroendoskopi tekniği kuadrigeminal araknoid kist ve beraberindeki hidrosefalinin tedavisi için uygun ve etkili bir yöntemdir.

Arachnoid Cyst: An Asymptomatic Exuberance

“…Interhemispheric arachnoid cysts are usually unilateral, midline, or parasagittal, away from ventricles, and usually not causing hydrocephalus [4]. Quadrigeminal cistern cysts are uncommon but usually compress the cerebral aqueduct at an early stage, presenting with hydrocephalus when symptomatic, and their treatment is imperative [5]. Arachnoid cysts located in the middle cranial fossa (approximately 50-65% of related cases) can be classified with the Galassi classification: type I cysts are small and usually asymptomatic, with anterior middle cranial fossa location; type II cysts are located superiorly along the Sylvian fissure displacing the temporal lobe; and type III cysts, like the case described, are exceptionally large, being able to take up the entire middle cranial fossa, displacing the temporal, parietal, and frontal lobes [6].…”

Arachnoid cysts of the quadrigeminal cistern: Proposal of a therapeutic algorithm based on a systematic review of literature

“…Essentially, hydrocephalus is the most common presentation observed on the majority of studies [20][21][22][23], and signs of intracranial hypertension such as headache, drowsiness, bulging fontanel, visual impairment, and macrocrania have been frequently reported [20]. Ideally, the goal of surgery is to restore the pathway of the CSF by performing fenestrations on the cyst wall that communicate to the normal subarachnoid space, ventricle, and other cisterns [19,24]. Alternatively, a diverting shunt could be inserted into the cyst to reduce the internal pressure and consequently the compression of the surroundings, even with an augmented risk of failure [21].…”

A review of common endoscopic intracranial approaches

“…[56] Due to their close proximity to the pineal quadrigeminal neurovascular structures, quadrigeminal cysts should undergo minimally invasive treatment. [57] Endoscopic treatment of quadrigeminal cysts has yielded good results, with shunt independency rates ranging from 78% to 92.9%. [58,59] In addition, Cinalli et al found that VC combined with ETV for quadrigeminal cysts leads to better outcomes than VC alone.…”