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Nakamasa Hayashi, Shunro Endo, Eiji Tsukamoto, Shuji Hohnoki, Toru Masuoka, and Akira Takaku

cistern ( Fig. 1 upper ). This lesion compressed the tectal plate anteriorly, causing aqueductal stenosis, and it also compressed the cerebellar vermis downward. Fig. 1. Upper: Preoperative midsagittal T 1 -weighted MR image revealing a quadrigeminal cistern arachnoid cyst distorting the tectal plate and cerebellar vermis. Note the compressed aqueduct of Sylvius. Lower: Postoperative midsagittal T 1 -weighted MR image revealing a decrease in the size of the cyst and a normal aqueduct of Sylvius. Operation The patient underwent endoscopic fenestration of the

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Michael A. Silva, Henry Chang, John Weng, Nicole E. Hernandez, Ashish H. Shah, Shelly Wang, Toba Niazi, and John Ragheb

in the sylvian fissure (49%), cerebellopontine angle (11%), and quadrigeminal cistern (5%–10%). 3 , 5 Quadrigeminal cistern arachnoid cysts (QACs), also described as tectal or pineal region arachnoid cysts, account for 5%–10% of arachnoid cysts. 3 , 6 While often asymptomatic and detected incidentally, large QACs can become symptomatic if they compress the brainstem or pineal region or cause obstructive hydrocephalus. 2 , 7 Children commonly present with symptoms of hydrocephalus, macrocephaly, developmental delay, or ocular symptoms from pineal compression, 1

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Giuseppe Cinalli, Pietro Spennato, Laura Columbano, Claudio Ruggiero, Ferdinando Aliberti, Vincenzo Trischitta, Maria Consiglio Buonocore, and Emilio Cianciulli

I n 1993, Di Rocco et al. 10 classified as “quadrigeminal plate cysts” the cysts that, originating in the quadrigeminal plate region, were entirely located in the supratentorial space. Actually, the cysts originating in the quadrigeminal cistern may have different extension toward surrounding regions, according to the presence of loci minoris resistentiae, such as the region of the trigone cranially, the supracerebellar cistern caudally, the third ventricle anteriorly, and the ambient cisterns laterally. Several options for the management of symptomatic

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Primary cerebellar hemorrhage

Quadrigeminal cistern obliteration on CT scans as a predictor of outcome

Mamoru Taneda, Toru Hayakawa, and Heitaro Mogami

displacement of the superior vermis and obliteration of the quadrigeminal cistern, which can be accurately detected by CT. 1, 13 Such CT findings due to the effect of the mass in the posterior fossa may relate to the degree of brain-stem compression by the cerebellar hemorrhage. The present study was carried out to evaluate the usefulness of the CT appearance of the quadrigeminal cistern in predicting outcome and also in the selection of patients for suboccipital craniectomy with evacuation of the cerebellar hematoma. Clinical Material and Methods Patient Population

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Rafael J. Tamargo, Jonathan I. Epstein, and Henry Brem

left ), A 1- to 2-mm incision was made with a microsurgical knife at the midpoint of the transverse occipital suture. Cerebrospinal fluid (CSF) flowed briskly when the subarachnoid space in the quadrigeminal cistern was penetrated. An equilateral triangular flap of the occipital plate was excised with the microscissors and saved, thus gaining wide access into the quadrigeminal cistern ( Fig. 1 left ). The CSF in the cistern was absorbed with a Weck-Cel surgical spear sponge. ‖ As much CSF as possible was removed from the cistern to create a cavity into which the

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Satoshi Matsuo, Serhat Baydin, Abuzer Güngör, Koichi Miki, Noritaka Komune, Ryota Kurogi, Koji Iihara, and Albert L. Rhoton Jr.

join before emptying into the tentorial sinuses. The posterior pericallosal vein, which drains the posterior part of the cingulate gyrus, empties around the splenium into the vein of Galen in the quadrigeminal cistern. E: Enlarged view. The internal cerebral, posterior pericallosal, basal, and superior vermian veins empty into the vein of Galen. The superior and inferior colliculi are located posterior and inferior to the pineal gland. The medial posterior choroidal artery courses beside the pineal gland and enters the velum interpositum in the roof of the third

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Zamzuri Idris, Jason Raj Johnson, and Jafri Malin Abdullah

features of the patient's brain MRI study was again the presence of a membranous layer connecting the lower splenium with the habenular complex ( Fig. 3A , B , and G ). She was scheduled to undergo neuronavigation-guided endoscopic surgery to divert the CSF into the quadrigeminal cistern without any attempt made to biopsy this highly vascular tumor, which had elevated tumoral markers. FIG. 3. Case 2. A: Sagittal MR image showing the presence of a tumor that occupies the third ventricle and causes hydrocephalus. There is a membranous layer connecting the lower

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Abdullah Keles, Burak Ozaydin, and Mustafa K. Baskaya

:53 Management After describing these findings and discussing viable treatment options with the patient and his family, we received their consent to proceed with a microsurgical excision of this meningioma using a paramedian supracerebellar transtentorial approach. This approach allows us an unobstructed exposure to the quadrigeminal cistern, tectal plate, pineal region, tentorial incisura, as well as medial basal temporal lobe and posterior ambient cistern, through the transtentorial route. Prior to surgery, due to hydrocephalus, we placed a right frontal

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Nasser M. F. El-Ghandour

A rachnoid cysts account for 1% of all intracranial lesions. 1 Quadrigeminal cistern arachnoid cysts (QACs) are rare, accounting for 5%–10% of all intracranial arachnoid cysts. 20 Although the clinical and radiological features of these cysts are well described in the literature, controversy remains concerning the best operative treatment. There are several surgical procedures available for QACs, including stereotactic aspiration, craniotomy and cyst excision or fenestration, ventriculoperitoneal or cystoperitoneal shunting, and combined procedures. 14

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Ahmet Metin Şanlı, Erhan Türkoğlu, Hayri Kertmen, and Bora Gürer

our case, solely located in the left ambient cistern and causing obstructive hydrocephalus due to extrinsic aqueductal stenosis, has never been described before. A cyst of the ambient cistern should be differentiated from arachnoid cysts of the quadrigeminal cistern to determine a suitable surgical procedure. The latter, originating in the quadrigeminal plate region, is located in the supratentorial space and may have different extensions toward surrounding regions, such as the ambient cisterns laterally, because of loci minoris resistentia. Recently, cysts of the