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

View More View Less
  • 1 Department of Neurosurgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami;
  • | 2 Florida State University, College of Medicine, Tallahassee; and
  • | 3 Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS

CSF = cerebrospinal fluid; ETV = endoscopic third ventriculostomy; QAC = quadrigeminal cistern arachnoid cyst; VP = ventriculoperitoneal.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Chheda MG, Wen PY. Uncommon brain tumors. UpToDate; 2020.Accessed November 22, 2021. https://www.uptodate.com/contents/uncommon-brain-tumors#!

    • Search Google Scholar
    • Export Citation
  • 2

    Lindsay K, Bone I, Fuller G. Neurology and. Neurosurgery Illustrated. 5th ed. Churchill Livingstone;2010.

  • 3

    Greenberg MS. Handbook of Neurosurgery. 9th ed. Thieme Publishers;2020.

  • 4

    Muhlestein WE, Maher CO. Incidental intracranial cysts in children. Pediatr Clin North Am. 2021;68(4):775782.

  • 5

    Yu L, Qi S, Peng Y, Fan J. Endoscopic approach for quadrigeminal cistern arachnoid cyst. Br J Neurosurg. 2016;30(4):429437.

  • 6

    Cinalli G, Spennato P, Columbano L, et al. Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases. J Neurosurg Pediatr. 2010;6(5):489497.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Gangemi M, Maiuri F, Colella G, Magro F. Endoscopic treatment of quadrigeminal cistern arachnoid cysts. Minim Invasive Neurosurg. 2005;48(5):289292.

  • 8

    Akutagawa K, Tamura G, Tsurubuchi T, Ishikawa E, Matsumura A, Inagaki T. Quadrigeminal arachnoid cyst with perinatal encephalocele. Childs Nerv Syst. 2020;36(7):13931397.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr. 2010;5(6):578585.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    El-Ghandour NM. Endoscopic treatment of quadrigeminal arachnoid cysts in children. J Neurosurg Pediatr. 2013;12(5):521528.

  • 11

    Di Rocco F, James SR, Roujeau T, Puget S, Sainte-Rose C, Zerah M. Limits of endoscopic treatment of sylvian arachnoid cysts in children. Childs Nerv Syst. 2010;26(2):155162.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Erşahin Y, Kesikçi H. Endoscopic management of quadrigeminal arachnoid cysts. Childs Nerv Syst. 2009;25(5):569576.

  • 13

    Gui S, Bai J, Wang X, et al. Assessment of endoscopic treatment for quadrigeminal cistern arachnoid cysts: a 7-year experience with 28 cases. Childs Nerv Syst. 2016;32(4):647654.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Garg K, Tandon V, Sharma S, et al. Quadrigeminal cistern arachnoid cyst: a series of 18 patients and a review of literature. Br J Neurosurg. 2015;29(1):7076.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Raffel C, McComb JG. To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?. Neurosurgery. 1988;23(3):338342.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 407 407 407
Full Text Views 37 37 37
PDF Downloads 52 52 52
EPUB Downloads 0 0 0