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

Abstract

Background 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.

Patient 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.

Results and Conclusion 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.

Keywords

arachnoid cyst - cyst fenestration - endoscopy - hydrocephalus

• References

• 1 Inamasu J, Ohira T, Nakamura Y , et al. Endoscopic ventriculo-cystomy for non-communicating hydrocephalus secondary to quadrigeminal cistern arachnoid cyst. Acta Neurol Scand 2003; 107: 67-71
• 2 Kirollos RW, Javadpour M, May P, Mallucci C. Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 2001; 17: 713-718
• 3 Gangemi M, Maiuri F, Colella G, Magro F. Endoscopic treatment of quadrigeminal cistern arachnoid cysts. Minim Invasive Neurosurg 2005; 48: 289-292
• 4 Ruge JR, Johnson RF, Bauer J. Burr hole neuroendoscopic fenestration of quadrigeminal cistern arachnoid cyst: technical case report. Neurosurgery 1996; 38: 830-837
• 5 Choi JU, Kim DS, Huh R. Endoscopic approach to arachnoid cyst. Childs Nerv Syst 1999; 15: 285-291
• 6 Hayashi N, Endo S, Tsukamoto E, Hohnoki S, Masuoka T, Takaku A. Endoscopic ventriculocystocisternostomy of a quadrigeminal cistern arachnoid cyst. Case report. J Neurosurg 1999; 90: 1125-1128
• 7 Di Rocco F, Yoshino M, Oi S. Neuroendoscopic transventricular ventriculocystostomy in treatment for intracranial cysts. J Neurosurg 2005; 103: 54-60
• 8 Hayashi N, Hamada H, Umemura K, Kurosaki K, Kurimoto M, Endo S. [Selection of surgical approach for quadrigeminal cistern arachnoid cyst]. No Shinkei Geka 2005; 33: 457-465
• 9 Tsutsumi S, Kondo A, Yasumoto Y, Ito M. Asymptomatic huge congenital arachnoid cyst successfully treated by endoscopic surgery—case report. Neurol Med Chir (Tokyo) 2008; 48: 405-408
• 10 Ohnishi YI, Fujimoto Y, Taniguchi M, Tsuzuki T, Taki T. Neuroendoscopically assisted cyst-cisternal shunting for a quadrigeminal arachnoid cyst causing typical trigeminal neuralgia. Minim Invasive Neurosurg 2007; 50: 124-127
• 11 Rhoton Jr AL. The cerebrum. Anatomy. Neurosurgery 2007; 61 (1, Suppl) 37-118 , discussion 118–119