Quadrigeminal Cistern Arachnoid Cyst Research Articles

Microscope neuronavigation-guided microsurgical fenestration of quadrigeminal cistern arachnoid cysts: how I do it.

Management options for treatment of quadrigeminal arachnoid cysts (QAC) include microsurgical/endoscopic fenestration or shunt. There is an open debate about which method is the best. Microsurgical fenestration is well suited for treatment of QAC with predominant infratentorial component and without hydrocephalus making endoscopic procedures more challenging. We describe the microsurgical technique and related anatomy to fenestrate infratentorial QAC through supracerebellar infratentorial approach. We also discuss our experiences with this approach, some of the drawbacks and nuances. Navigation-guided microsurgical fenestration of infratentorial QAC is the authors' surgical approach of choice for treating these rare challenging lesions when not associated with hydrocephalus.

Neuroendoscopic Fenestration of Quadrigeminal Cistern Arachnoid Cyst Presenting with Developmental Regression

Quadrigeminal cistern arachnoid cyst is rare and not usually located in the tectal plate region. Such a cyst may extend to the surrounding area and compress adjacent structures due to cystic expansion. Arachnoid cysts occasionally are associated with hydrocephalus and produce related symptoms. In our case, a 20-month-old boy presented with developmental regression and macrocephaly. Image study of the brain demonstrated a large cyst on the superior portion of the posterior fossa with extension to the supratentorial space and a compressed cerebellum inferiorly and brain stem anteriorly. Lateral and third ventricles were enlarged severely. We performed lateral ventriculo-cystostomy by neuroendoscope via a precoronal approach. Additional third ventriculostomy was performed on the floor of the third ventricle. At 9 months after surgery, the patient showed restored development, and postoperative image showed a reduction of arachnoid cysts and lateral and third ventricles.

Surgical management of quadrigeminal cistern arachnoid cysts: case series and literature review.

Quadrigeminal cistern arachnoid cysts (QACs) are congenital lesions that can cause pineal region compression and obstructive hydrocephalus when sufficiently large. Management of these cysts is controversial and rates of reintervention are high. Given the limited data on the management of QACs, the authors retrospectively reviewed 20 years of cases managed at their institution and performed a literature review on this topic. The authors performed a retrospective analysis of patients treated for QAC at their institution between 2001 and 2021. They also performed a literature review of studies published between 1980 and 2021 that reported at least 5 patients treated for QACs. Patient characteristics, radiographic findings, management course, and postoperative follow-up data were collected and analyzed. A total of 12 patients treated for a QAC at the authors' institution met the inclusion criteria for analysis. Median age was 9 months, mean cyst size was 5.1 cm, and 83% of patients had hydrocephalus. Initial treatment was endoscopic fenestration in 92% of these patients, 27% of whom had an endoscopic third ventriculostomy (ETV) performed concurrently. Reintervention was required in 42% of patients. Cases that required reintervention had a statistically significant lower median age at the initial intervention (5 months) than the cases that did not require reintervention (24.33 months; p = 0.018). There were no major complications. At a mean follow-up of 5.42 years, 83% of patients had improvement or resolution of their symptoms. A literature review revealed 7 studies that met the inclusion criteria, totaling 108 patients with a mean age of 8.8 years. Eighty-seven percent of patients had hydrocephalus at presentation. Ninety-two percent of patients were initially treated with endoscopic fenestration, 44% of whom underwent concurrent ETV. Complications occurred in 17.6% of cases, and reintervention was required in 30.6% of cases. The most frequent reason for reintervention was untreated or unresolved hydrocephalus after the initial procedure. Endoscopic fenestration is the most common treatment for QACs. While generally safe and effective, there is a high rate of reintervention after initial treatment of QACs, which may be associated with a younger age at the first intervention. Additionally, identifying patients who require initial treatment of hydrocephalus is critically important, as the literature suggests that untreated hydrocephalus is a common cause of reintervention.

Quadrigeminal cistern arachnoid cyst causing hydrocephalus.

The quadrigeminal cistern is an unusual location for these cysts. Quadrigeminal arachnoid cysts account for 5% to 10% of all intracranial arachnoid cysts. They are frequently diagnosed coincidentally on computed tomography (CT) or magnetic resonance imaging (MRI). They cause symptoms when they become sufficiently large to compress the adjacent brain structures. Endoscopic fenestration of the cyst with cystocisternostomy or cystoventriculostomy, when combined with third ventriculostomy, is the procedure of choice for such patients. A 14-month-old boywas referred to neurosurgery clinic due to increased head circumference. His had been in good health until age 8 months, between age 9 and 13 months his acquisition of developmental skills was slow. Magnetic resonance image (MRI) demonstarted enlargement of the supratentorial ventricular system secondary to a large quadri-geminal cistern arachnoid cyst compressing the brainstem, cerebellum, aqueduct of Sylvius and fourth ventricle. The cystic mass appeared hyperintense on T2 weighted-images (A, B), hypointense on T1-WI (C, D), similar to cerebrospinal fluid (CSF) signal, without enhancement after Gadolinium administration. The patient was operated by transventricular approach with endoscopic third ventriculocystostomy and endoscopic third ventriculostomy (ETV). The postoperative course was uneventful.

Lesión como malformación de Chiari secundaria a quiste aracnoidal de la cisterna cuadrigémina

Se presenta el caso de una mujer de 31 años de edad con cefalea y cervicalgia que se agravaba con la maniobra de Valsalva, presentando además mareos, encontrándose una malformación de Chiari secundario a un quiste aracnoideo cuadrigeminal. Después de efectuada la resonancia magnética diagnóstica, la paciente fue sometida a descompresión del agujero magno y extirpación del quiste cuadrigeminal, seguido por la resolución tanto de la malformación de Chiari y el quiste. Los síntomas desaparecieron después de la cirugía y han permanecido completamente resuelto hasta la actualidad. En pacientes adultos que presentan signos y síntomas de una malformación de Chiari debido a la compresión de la médula por las las amígdalas cerebelosas, la presencia de un quiste aracnoideo de cisterna cuadrigéminal es una rara patología asociada que puede ser tratada quirúrgicamente.

Endoscopic Management of Arachnoid Cysts

Object: Arachnoid cysts are developmental space-occupying lesions filled with CSF-like content and surrounded by a membrane resembling arachnoid mater, with controversial etiology and natural history. Endoscopy has been successfully used for decades to treat a variety of pathologies within thecentral nervous system. Methods: Thirteen patients who underwent endoscopic fenestration for treatment of arachnoid cyst were selected for this study. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Results: Five patients had middle fossa cysts; 2 a posterior fossa cyst; 3 a quadrigeminal cistern arachnoid cyst and 3 a suprasellar arachnoid cyst. Endoscopic management consisted in a cystoventriculostomy in 8 patients and cystocisternotomy in 5 patients. There was neither mortality nor operative morbidity. Discussion: Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid containing cisterns. Conclusion: Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensitycombine to make this a safe procedure with excellent outcomes.

Endoscopic approach for quadrigeminal cistern arachnoid cyst

Objectives Quadrigeminal cistern arachnoid cysts (QCACs), which are usually asymptomatic and may be accidental findings during radiological evaluation, are rare, comprising 5–10% of all intracranial arachnoid cysts (ACs). We report a series of eight patients with QCACs treated with neuroendoscopic intervention and try to discuss the different endoscopic approaches according to the different types of QCACs. Materials and methods Between October 2007 and January 2013, eight patients affected by QCACs were endoscopically treated. All the endoscopic procedures were completed uneventfully (infratentorial approaches in four cases and supratentorial approaches in four cases), which included ventriculocystostomy in seven cases (lateral ventriculocystostomy in one case, third ventricle cystostomy in five cases and both in one case), endoscopic third ventriculostomy in three cases and cystocisternostomy in one case. Results Five patients achieved complete cure after the endoscopic procedure alone; nevertheless, in none of the patients did the cyst totally collapse following the endoscopic procedure during follow-up. The number of episodes decreased significantly even after cessation of all medications and headache disappeared in one patient and the two patients who had unsteady gait together with visual complaints showed remarkable improvement. Conclusion QCAC is one kind of pineal region ACs and it is advisable to plan the operative approach before the endoscopic procedure according to the different types of pineal region ACs. Pineal region ACs and the associated hydrocephalus can be successfully treated with simple, minimally invasive endoscopic procedure.

Assessment of endoscopic treatment for quadrigeminal cistern arachnoid cysts: A 7-year experience with 28 cases.

Quadrigeminal cistern arachnoid cysts (QACs) are difficult to treat because of their deep location and the presence of nervous and vascular structures of the pineal-quadrigeminal region. There are several surgical procedures available for QACs, including craniotomy and cyst excision or fenestration, ventriculoperitoneal or cystoperitoneal shunting, and endoscopic fenestration. There is a debate about which method is the best. The aim of this study is to evaluate the effectiveness and safety of endoscopic ventriculocystostomy (VC) and third ventriculostomy (ETV) for treatment of arachnoid cysts of the quadrigeminal cistern. Twenty-eight patients with QACs who had undergone endoscopic treatment in our department between August 2007 and June 2014 were studied retrospectively. Patient age at the time of endoscopic treatment ranged from 5 months to 42 years, including 25 children (14 males and 11 females) and 3 adults (one male and two females). All patients presented with hydrocephalus and did not undergo shunting prior to neuroendoscopic surgery. The first endoscopic procedures included lateral ventricle cystostomy (LVC) together with ETV in 18 cases, third ventricle cystostomy (3rd VC) together with ETV in 3 cases, and double VC (3rd VC and LVC) together with ETV in 7 cases. Data were obtained on clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and the results of clinical and neuroradiological follow-up. Complete success was achieved in 25 (89.3 %) of 28 cases. During the follow-up period, one case underwent endoscopic reoperation with success. Shunts were implanted in 2 patients due to progression of symptoms and increase in hydrocephalus after the first endoscopic operation. Shunt independency was achieved in 26 (92.9 %) of 28 cases. The cyst was reduced in size in 22 cases (78.6 %). Postoperative images showed a reduction in the size of the ventricles in 23 cases (82.1 %). There was no surgical mortality. Subdural collection developed in 4 cases (14.3 %) and required a transient subduroperitoneal shunt in 2 cases, whereas the other 2 patients were asymptomatic and did not require any surgical treatment. VC together with ETV through precoronal approach is an effective treatment for symptomatic QACs and should be the initial surgical procedure. The surgical indications should include signs of elevated ICP (including increased head circumference), Parinaud syndrome, gait ataxia, and nystagmus. Also, surgery is indicated by progressive enlargement of the cyst and young children with large cysts even if the patients are asymptomatic. Contraindications to surgery include the absence of symptoms (older children and adult) and isolated developmental delay. The main criterion for successful surgery should be improvement of clinical symptoms instead of reduced cyst volume and/or ventricular size. Repeated endoscopic procedures may be considered only for the patients whose symptoms improved after first endoscopic operation.

Quadrigeminal cistern arachnoid cyst: A series of 18 patients and a review of literature

Background. Arachnoid cysts account for 1% of intracranial mass lesions. Quadrigeminal cistern arachnoid cysts are even rarer lesions. We report 18 cases of quadrigeminal cistern arachnoid cysts treated at our institute from 2002 to 2012. Methods. We retrospectively analysed 18 patients with quadrigeminal cistern arachnoid cyst for clinical presentation, demographic profile, management and outcome. The age of the patients ranged from 29 days to 50 years (mean 17 years). The cysts were classified into 3 subtypes based on MRI findings. Surgical intervention was carried out in all the patients. Results. Two patients had Type 1 cysts, 4 had Type 2 cysts and 12 had Type 3 cysts. Two patients (Type 1) underwent endoscopic third ventriculostomy (alone). Craniotomy and cyst wall excision along with ventriculocystostomy and cystocisternostomy were done in 4 patients with Type 2 cysts, and endoscopic fenestration of cysts to the sub-arachnoid space or the ventricles and endoscopic third ventriculostomy were done in 7 patients with Type 3 cysts. Two patients with Type 3 cysts underwent only endoscopic ventriculocystostomy and cystocisternostomy without endoscopic third ventriculostomy, while three patients underwent ventriculoperitoneal shunt. The follow- up period ranged from 6 months to 48 months (mean 23.7 ± 12.3 months). Conclusion. Quadrigeminal plate arachnoid cysts are generally symptomatic and require some form of surgical intervention. We believe that endoscopic fenestration of the cyst with cystocisternostomy or cystoventriculostomy, when combined with third ventriculostomy, is the procedure of choice for such patients. We do not recommend the placement of a ventriculoperitnoeal shunt alone. Operative re-exploration should be planned only after obtaining proper clinico-radiological correlation and not on the basis of imaging findings alone, as sometimes the cysts fail to regress but the symptoms improve.

Quadrigeminal Cistern Arachnoid Cyst Treated by Endoscopic Ventriculocystostomy through the Trigonal Region

When symptomatic, quadrigeminal cistern arachnoid cysts (QCACs), comprising 5 to 10% of all intracranial arachnoid cysts, are treated by open fenestration or shunt placement and in recent decades by endoscopic techniques. We introduce a novel endoscopic technique that may be used for surgery of QCACs. A 52-year-old woman with a known history of QCAC (treated twice previously by open procedures) presented with symptoms, signs, and radiologic indicators of shunt malfunction and cyst recollection. Because of high-riding pineal gland and distortion of anatomy that resulted from the last surgeries, and loss of a suitable visual angle, a satisfactory ventriculocystostomy was not possible through the third ventricle. Therefore, the cyst was approached by entering the trigonal region of the lateral ventricle, allowing to perform ventriculocystostomy. Postoperative imaging and follow-up visits proved this approach to be efficacious. This report, for the first time, introduces the so-called transtrigone lateral ventricle cystostomy as an alternative for cases of QCAC for which the ventriculocystostomy via the third ventricle is not suitable.

Regression of cerebellar tonsillar descent and hydrocephalus after endoscopic third ventriculostomy in a patient with a quadrigeminal arachnoid cyst

Background:Posterior fossa arachnoid cysts, including quadrigeminal cistern arachnoid cysts, can occasionally cause compression of the quadrigeminal plate, leading to Sylvian aqueduct stenosis and induction of cerebellar tonsillar descent into the foramen magnum. This, in turn, can result in obstructive hydrocephalus. In such cases, the characteristic of hydrocephalus is generally considered to be hypertensive.Case Description:We present the case of a 28-year-old female complaining of chronic and progressively worsening headaches following the delivery of her first child. Magnetic resonance imaging revealed marked tri-ventriculomegaly, the arachnoid cyst located in the quadrigeminal cistern, and cerebellar tonsillar descent. Ophthalmoscopy revealed bilateral papilledema indicating a long-standing elevation of intracranial pressure. Endoscopic third ventriculostomy (ETV) was performed successfully and resulted in complete recovery from her headaches and papilledema. Postoperative MRI revealed resolution of ventriculomegaly and cerebellar tonsillar descent, suggesting that the fourth ventricle outlet obstruction was associated with the development of the hydrocephalus in this patient.Conclusion:Our case is the first report that a quadrigeminal arachnoid cyst associated with both cerebellar tonsillar descent and hydrocephalus was well treated with ETV. It was indicated that the patient's hydrocephalus and cerebellar tonsillar descent were secondary and synergistic events, caused by the arachnoid cyst located in the quadrigeminal cistern.

Endoscopic supracerebellar infratentorial parapineal approach for third ventricular colloid cyst in a patient with quadrigeminal cistern arachnoid cyst: Case report

Department of Neurology Botucatu Medical School Sao Paulo State University (UNESP), Rubiao Jr S/N Caixa Postal: 54018618-970, Botucatu, SP

Neuroendoscopic Approach to Quadrigeminal Cistern Arachnoid Cysts

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. 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. 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. Neuroendoscopic technique is an effective and suitable method for the treatment of quadrigeminal cistern arachnoid cysts and accompanying hydrocephalus.

Neuroendoscopic treatment of different types of quadrigeminal cistern arachnoid cysts

To evaluate the method, strategy and efficacy of treating different types of quadrigeminal cistern arachnoid cysts (QCAC) with neuroendoscope. A retrospective analysis was conducted for 12 QCAC patients with obstructive hydrocephalus. They were classified into 3 types and underwent neuroendoscopic operation at our hospital between November 2005 and November 2009. Their surgical approaches, complications and efficacy were analyzed. The mean age of first diagnosis was 3.7 years old. There were 7 type II cases and 5 type III cases with a varying level of symptoms. The follow-up period was 6 - 24 months. Cine-MRI (magnetic resonance imaging) examination was performed both preoperatively and post-operatively. Among them, 12 patients recovered well without any occurrence of hemorrhage, paralysis, lower cranial nerve injury, cerebrospinal fluid leakage, infection or death. Subdural effusion occurred in 3 cases, but disappeared within 6 months. Seven feverish cases recovered after a symptomatic treatment. The shapes of cysts and ventricles almost returned to a normal level in 8 cases. Three cases of arachnoid cyst had a slight change. In accordance with the QCAC patient types, different neuroendoscopic approaches can fully reconstruct the cerebrospinal fluid circulation. And the use of frameless navigation makes it more precise and safe.

Neuro-endoscopic treatment for intraventricular cysts in children

Objective To study the technical key points and effects of neuro-endoscopic treatment for intravcntricular cysts in children, and to analyze the features of velocity and flux of cerebrospinal fluid in patients of intraventricular cysts. Method Cine MRI was used to analyze the velocity and flux of eerebrospinal fluid. Among all the cases,there were 8 lateral ventricles cysts,2 third ventricle cysts,4 fourth ventricle cysts, 2 suprasellar araehnoid cysts and 1 quadrigeminal cistern arachnoid cyst. The neuro-endoscopic operation was performed to all kinds of intraventricular cysts in order to study the indication, optimal process and clinical effects. Results The CSF dynamic states were improved in all patients. It was found that the CSF passed through the stoma after ETV in all patients. The contraction of cyst was found in 14 cases, and there was no notable change in 3 cases. The total effective rate was 82. 4%. There was no surgery -related serious complication. The cyst enlargement or stoma obstruction was not found in all patients after 3 -19 months follow-up period. Conclusions Cine MRI and radionuclide cisternography are helpful to understand the CSF dynamic states in children with intraventricular cysts and they are important references for surgery and determination of prognosis. Neuronavigated endoscopic surgery may be more precise and safe. Post-operative lumbar puncture is helpful to reconstruct normal CSF circulation and improve the prognosis. Key words: Cerebral ventricles ; Cysts; Endoscopes; Hydrocephalus; Cine-MRI; Radionuclide cisternography

Endoscopic therapy for obstructive hydrocephalus caused by cysts in the pathway of CSF circulation

To explore the process and technique of neuroendoscopic operation to treat obstructive hydrocephalus caused by cysts located in the pathway of CSF circulation. The cine MRI examinations and endoscopic operations were taken to treat 30 cases with obstructive hydrocephalus. Among all the cases, there are 11 intraventricular cysts (8 lateral ventricular cysts, 4 fourth ventricular cysts), 4 suprasellar arachnoid cysts, 1 quadrigeminal cistern arachnoid cyst, 6 Dandy-Walker malformations and 8 posterior fossa arachnoid cysts. CSF dynamic of all patients improved to different extents post-operation. It was observed that CSF passed through the stoma after ETV in all patients. The volume of 9 intraventricular cysts, 4 suprasellar arachnoid cysts, 1 quadrigeminal cistern arachnoid cyst and 4 posterior fossa arachnoid cysts diminished for different degrees. There were no surgery-related serious complications or deaths. There were not cyst enlarged and stoma obstructed cases. Obstructive hydrocephalus caused by cysts in the pathway of CSF circulation is the optimal indication for neuro-endoscopic surgery. After resecting cyst partially, we should take the endoscopic third ventriculostomy to rebuild the passway of CSF and elevate the cranial compliance. Cine MRI and radionuclide cisternography are helpful to understand the CSF dynamic and absorption.

Endoscopic management of quadrigeminal arachnoid cysts

Quadrigeminal cistern arachnoid cysts are rare lesions, accounting for 5% to 10% of all intracranial arachnoid cysts and 9% of all supratentorial localizations. We reviewed the patients with quadrigeminal arachnoid cyst (QAC) who were treated with neuroendoscopic intervention. Seventeen patients with QAC had been operated on between 2000 and 2007 in our institution. Four patients had undergone shunting prior to neuroendoscopic surgery. There were nine girls and seven boys with age ranging from 7 days to 17 years (mean, 40 months). All patients had hydrocephalus. A wide ventriculocystostomy (VC) and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. An aqueductal stent was also placed in two of the patients. Psychometric evaluation was administered postoperatively when possible. Follow-up of the patients ranged from 6 to 96 months (mean, 51.8 months). Of the 17 patients, 12 underwent endoscopic procedure as the primary surgery. Five patients had been previously shunted. Macrocrania and psychomotor retardation were the main symptom and sign in all infants with QAC. Older children presented with the symptoms and signs of intracranial hypertension. Of the eight patients who were 6 months old or younger, only one did not need a ventriculo-peritoneal (VP) shunt. Endoscopic procedures were successful in all patients older than 6 months of age (P=0.005). The patients presenting in their infancy had a psychomotor retardation, and all patients except for one, younger than 6 months of age, needed a VP shunt. Neuroendoscopic procedure is effective particularly in the patients with QAC older than 6 months of age.

Endoscopic management of intra and paraventricular CSF cysts

The management of intra- and paraventricular lesions is one of the fields in which modern neuroendoscopic techniques have given the most significant contribution in terms of reduction in operative invasiveness and postoperative complications. In this context, fluid cysts represent an ideal ground on which results obtained with traditional surgical procedures (open surgery, shunting) have more and more to compare with the increasing number of encouraging results obtained by neuroendoscopy. The objective of this study was to retrospectively evaluate the results of the endoscopic treatment of intra- and paraventricular cysts performed at our institution and how they compare with what has been reported in the literature, concerning the results of open surgery, shunting, and endoscopic management. All the patients with intra- and paraventricular cerebrospinal fluid (CSF) cysts endoscopically managed at our institution between March 2000 and October 2006 were included. Based on cyst location documented by magnetic resonance imaging (MRI), the cohort of patients examined was subdivided in five groups: A, paraventricular cysts; B, choroids plexuses cysts; C, secondary intraventricular cysts in previously hydrocephalus shunted patients; D, quadrigeminal cistern arachnoid cysts; and E, suprasellar arachnoid cysts. The neuroendoscopic procedures were performed with a 30 degrees rigid endoscope (Storz Decq, 3.8 mm). The surgical plan and best trajectory were selected on preoperative MR imaging. Postoperatively, all patients underwent CT scans in the first 48 h after surgery and MR control 3 months after surgery. There were 26 patients (18 M/8F). The mean age at diagnosis was 8.95 years. Five of 26 cases were adult patients. Four patients had paraventricular cysts; 2 patients had a choroids plexuses cyst; 6 patients a secondary intraventricular cyst in previously shunted hydrocephalus; 11 patients had a quadrigeminal cistern arachnoid cyst and 3 patients had a suprasellar arachnoid cyst. Fifteen patients had an associated hydrocephalus at the time of the surgical treatment (one patient in group A, six patients in group C, six in group D, and two in group E). Twenty-three out of 26 patients underwent endoscopic management of their cystic lesion as primary procedure; in the remaining three cases, it represented a secondary procedure after open cyst marsupialization or/and the implant of a cystoperitoneal shunt. Endoscopic management consisted in a cystoventriculostomy (CV) in 19 patients. Third ventriculostomy (ETV) was associated to CV in seven cases, and it was performed at the same time of the CV procedure in all these cases. There was no mortality, neither operative morbidity. At a mean follow-up of 2.15 years (0.1-4 years), a complete resolution of preoperative clinical symptoms and signs was recorded in 80.9% of symptomatic patients. Control MRI showed a reduced cyst size in 25/26 patients and a stable cyst size in the last case, with signs of CSF flow between the cyst and the cerebral ventricles in all cases. One out of 15 patients with associated hydrocephalus had a persistent ventriculomegaly without signs of increased intracranial pressure. Our results confirm that endoscopic management of intra- and paraventricular cysts is a valid alternative to open surgery as well as to shunting procedures. Control of clinical symptoms and signs was obtained in around 80% of our patients, while radiological evidence of cyst size reduction occurred in more than 95% of them. These rates are comparable with results of open surgery and shunting. The main advantage of neuroendoscopy is the low incidence of complications, a result that is confirmed by the present series.

Neuroendoscopically Assisted Cyst-Cisternal Shunting for a Quadrigeminal Arachnoid Cyst Causing Typical Trigeminal Neuralgia

A quadrigeminal cistern arachnoid cyst is a very rare cause of typical trigeminal neuralgia. A 62-year-old woman presented with right facial pain of 8 years duration. Neuroradiological findings revealed a cystic mass in the quadrigeminal region that compressed the cerebellum downward and the brainstem anteriorly and was associated with hydrocephalus. She had neuroendoscopically-assisted cyst-cisternal shunting via a small craniotomy. Postoperatively, the trigeminal neuralgia disappeared. The origin of the trigeminal neuralgia may have either been a marked distortion of the pons that caused stretching of the trigeminal nerve and irregular demyelination within the root entry zone, or there was contact between the root entry zone and a vascular structure. Neuroendoscopy is useful for treating arachnoid cysts; however, in order to safely relieve symptoms, the procedure needs to be appropriately adapted depending on the pathogenesis. In this paper, we review the literature and discuss the pathophysiology and treatment of our case.

Quadrigeminal Cistern Arachnoid Cyst in a Patient With Kabuki Syndrome

Kabuki syndrome is a rare dysmorphic disorder characterized by peculiar facial appearance, developmental delay, skeletal abnormalities, mental retardation, and dermatoglyphic abnormalities. Neurologic anomalies are frequently observed. This report presents a 2-year-old male with Kabuki syndrome who had a quadrigeminal cistern arachnoid cyst: the second case of such an association to be reported in the literature.