Neuroendoscopically assisted cyst-cisternal shunting for a quadrigeminal arachnoid cyst causing typical trigeminal...

A quadrigeminal cistern arachnoid cyst is a very rare cause of typical trigeminal neuralgia. A 62-year-old woman presented with right facial pain of 8 years duration. Neuroradiological findings revealed a cystic mass in the quadrigeminal region that compressed the cerebellum downward and the brainstem anteriorly and was associated with hydrocephalus. She had neuroendoscopically-assisted cyst-cisternal shunting via a small craniotomy. Postoperatively, the trigeminal neuralgia disappeared. The origin of the trigeminal neuralgia may have either been a marked distortion of the pons that caused stretching of the trigeminal nerve and irregular demyelination within the root entry zone, or there was contact between the root entry zone and a vascular structure. Neuroendoscopy is useful for treating arachnoid cysts; however, in order to safely relieve symptoms, the procedure needs to be appropriately adapted depending on the pathogenesis. In this paper, we review the literature and discuss the pathophysiology and treatment of our case.