Management of pediatric quadrigeminal arachnoid cysts: a systematic review and illustrative case report

Quadrigeminal arachnoid cysts (QACs) are often incidental but may present with compressive symptoms on surrounding brain structures. This study evaluates management strategies and outcomes in the literature and highlights the feasibility and importance of neuroendoscopic treatment in resource-limited settings using an illustrative case.

Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Google Scholar, Embase, and SCOPUS databases to identify and assess primary articles exploring pediatric QAC cases. Additionally, we present an illustrative case report.

We identified 32 articles for analysis. Males constituted 57.4% (128/223) of cases. Most patients (98.1%, 208/212) were symptomatic. Common symptoms included macrocephaly (49.6%, 117/236) and hydrocephalus (24.5%, 56/229). Endoscopic approaches included ETV alone (7.1%, 15/211), ETV with cyst fenestration (ETV/CF) (28%, 59/211), and cyst fenestration alone (13.7%, 29/211). Cyst reduction was achieved in 80.5% (136/169) of cases. Postoperative cyst recurrence was low (1.3%, 3/226), as were complications such as intraoperative bleeding (1.9%, 3/159) and infections (drain infection, 1.9%; meningitis, 0.6%). The mortality rate was 1.3% (3/237). VP shunting (16.3%, 22/135) and ETV (8.9%, 12/135) were the most common reintervention procedures.

ETV-only and ETV/CF are reasonable options in the surgical management of QACs, with reported low rates of complications and comparable reintervention rates. Although access to neuroendoscopy is limited in the subregion, this review and illustrative case report shed light on the potential impact neuroendoscopy can have on the care of such cases.