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088. Surgical management of quadrigeminal cistern arachnoid cysts: 20-year institutional experience

Authors: Nicole Eva Hernandez

Introduction:
Quadrigeminal cistern arachnoid cysts are uncommon posterior fossa lesions that often present in childhood. Management of these cysts and the hydrocephalus often associated with them is a challenge, and the need for re-intervention is common. Optimal management of these lesions is controversial and there is limited data in the literature on this topic.Methods: We retrospectively reviewed 20 years of surgical records at our institution and compiled data on all 13 patients with quadrigeminal cistern arachnoid cysts that were treated surgically and had adequate postoperative follow up. We extracted data on patient demographics, presenting symptoms, cyst dimensions, surgical approach, complications, need for reintervention, and radiographic and clinical improvement on follow up.
Results:
A total of 13 patients with quadrigeminal cistern arachnoid cysts treated at our institution met our inclusion criteria. Mean age at treatment was 5.2 years. Hydrocephalus was present in 10/13 (77%) patients. Endoscopic cyst fenestration was the first intervention in 11/13 (85%) patients and an endoscopic third ventriculostomy was performed concomitantly in 4 of these 11 patients (36%). Reintervention was required in 6/13 patients (46%), two of which required more than one reoperation. After a mean follow up of 6.3 years, 92% of patients had improvement or resolution of their symptoms.
Conclusion:
Endoscopic fenestration is a good initial treatment choice for many children with quadrigeminal cistern arachnoid cysts. Reoperation is more likely to be required in children less than 1 year of age, as these young children often require treatment of their hydrocephalus in addition to cyst fenestration.