Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases
- 1 November 2010
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery: Pediatrics
- Vol. 6 (5), 489-497
- https://doi.org/10.3171/2010.8.peds08491
Abstract
In this paper, the authors' goal was to evaluate the role of neuroendoscopy in the treatment of arachnoid cysts of the quadrigeminal cistern. 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. 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. 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.This publication has 22 references indexed in Scilit:
- Endoscopic Treatment of Quadrigeminal Cistern Arachnoid Cystsmin - Minimally Invasive Neurosurgery, 2005
- Effect of subthalamic stimulation on mood state in Parkinson’s disease: evaluation of previous facts and problemsNeurosurgical Review, 2005
- The endoscopic management of arachnoidal cystsNeurosurgery Clinics of North America, 2004
- Endoscopic ventriculocystocisternostomy of a quadrigeminal cistern arachnoid cystJournal of Neurosurgery, 1999
- Usefulness of Neuroendoscopy in Treating Supracollicular Arachnoid Cysts —Case Report—Neurologia medico-chirurgica, 1998
- Neuroendoscopic approach to arachnoid cystsJournal of Neurosurgery, 1996
- Burr Hole Neuroendoscopic Fenestration of Quadrigeminal Cistern Arachnoid Cyst: Technical Case ReportNeurosurgery, 1996
- Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy?Journal of Neurosurgery, 1996
- Burr Hole Neuroendoscopic Fenestration of Quadrigeminal Cistern Arachnoid Cyst: Technical Case ReportNeurosurgery, 1996
- Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shuntingJournal of Neurosurgery, 1991