Surgical management of quadrigeminal arachnoid cysts in children: A single-center study of 15 cases according to the Cinalli classification.

Quadrigeminal arachnoid cysts (QACs) are rare intracranial lesions frequently presenting with obstructive hydrocephalus in children. This study aimed to evaluate surgical strategies and clinical outcomes in pediatric patients with QACs classified according to the Cinalli classification. We retrospectively reviewed radiological and clinical data of 15 pediatric patients undergoing surgery for QACs (endoscopic third ventriculostomy (ETV), endoscopic cyst fenestration (CF), cystoperitoneal shunting, or microsurgical fenestration via craniotomy) at a single institution. Patients were categorized as Cinalli Types 1 (n = 9), 2 (n = 5), or 3 (n = 1). Shunt dependency, reoperations, complications, and long-term outcomes were compared between Cinalli subtypes. Eleven of the 15 patients achieved shunt independence over an overall mean follow-up period of 8.2 years (range: 6 months to 14 years). Five out of nine patients with Type 1 cysts were successfully managed endoscopically; the remaining four required shunting because of their very young age at diagnosis (n = 2) or preexisting shunt dependency (n = 2). All patients with Types 2 and 3 QACs were managed without shunt dependency. The most common complication was cerebrospinal fluid fistula (n = 2/15). One patient developed an intraventricular hemorrhage that was successfully managed with external ventricular drainage. No patient required late reoperations. Endoscopic treatment, particularly ETV combined with CF, is a highly effective first-line strategy for QACs, especially in older children. Although shunt independence is the primary therapeutic goal, patient age and prior shunt history are critical determinants of success. Microsurgical approaches remain valuable alternatives in symptomatic patients without hydrocephalus.