Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this paper, the authors' goal was to evaluate the role of neuroendoscopy in the treatment of arachnoid cysts of the quadrigeminal cistern.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between March 1995 and February 2008, 14 patients affected by arachnoid cysts of the quadrigeminal cistern were treated endoscopically. The cysts were classified according to their anatomical and radiological appearance. The most frequent form (Type I) extended infratentorially and supratentorially with a dumbbell shape. Type II cysts were confined to the infratentorial space and were associated with the most severe and acute form of hydrocephalus. Type III cysts presented a significant asymmetric expansion toward the temporal fossa. Ten patients underwent an endoscopic procedure as primary treatment and 4 as an alternative to shunt revision. In 6 cases, the first endoscopic procedure was ventriculocystostomy (VC) together with endoscopic third ventriculostomy (ETV). In the other 8 cases, the first endoscopic procedure was VC alone.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In the 6 cases in which VC was performed with an ETV, the procedure was successful, and the patients did not require further surgery. Of the 8 cases in which the first endoscopic procedure performed was VC without ETV, 7 underwent reoperation. Four of these patients underwent endoscopic procedures (by reopening the obstructed VC and performing ETV or cystocisternostomy) 2, 4, 4, and 5 months later with final success in all cases. Three patients (all of whom were previously treated using ventriculo- or cystoperitoneal shunts) required shunt reimplantation (complete failure). Subdural collection developed in 1 case, which was managed by transient insertion of a subduroperitoneal shunt. Neurological and developmental outcomes were good except for 1 patient who did not show improvement in preoperative developmental delay. No transient or permanent morbidity or mortality was observed.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The analysis of this series suggests that arachnoid cysts of the quadrigeminal cistern and the associated hydrocephalus can be effectively treated by endoscopy; this approach allows the patient to be shunt independent in more than 78% of the cases. If endoscopy is used as first option, the success rate of endoscopic procedures observed in this series was 90%. Endoscopic third ventriculostomy should be associated with a VC to offer the highest success rate with a single procedure.</jats:p></jats:sec>

Neuroendoscopic Approach to Quadrigeminal Cistern Arachnoid Cysts

“…According to Almeida et al, 79 cases were reported in the literature up to 2008 [2]. A Pubmed search revealed 38 new cases since then [5][6][7][8][9][10][11][12][13][14].…”

“…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.…”

Ventricular endoscopy in the pediatric population: review of indications

“…The underlying treatment goal is to drain or divert the contained CSF within the arachnoid cyst. The described approaches include stereotactic aspiration, craniotomy with excision of cyst, cyst fenestration, cystocisternostomy, ventriculocystostomy, and cystoperitoneal shunting [87]. Recent advances in neuroendoscopy have resulted in most of the arachnoid cysts being treated with endoscopic fenestration [88,89].…”

“…These endoscopic approaches have been modified by burr hole location and use of stereotaxy to allow for fenestration of quadrigeminal [87,90], suprasellar [75,[91][92][93][94], middle fossa [79], prepontine [95], interhemispheric [96], retroclival [97], and third ventricular arachnoid cysts [94] with satisfactory outcomes.…”

“…For less common arachnoid cysts, such as those within the quadrigeminal cistern, endoscopic cystostomy demonstrates a high success rate in combination with ETV, particularly in patients greater than 6 months of age [87]. In instances where cysts may extend into the third ventricle, a bipolar fenestration into the ventricle and basal cistern can help decompress the cyst and leave the patient shunt-free [94].…”