Quadrigeminal cistern cystic hemangioblastoma: A transcystic approach

Introduction: Hemangioblastomas typically present throughout the neuroaxis, particularly within the cerebellum and spinal cord. A rare case of cystic hemangioblastoma within the quadrigeminal cistern is described. Case Report: A 18-year-old female presented with 3 weeks of worsening headaches and vomiting. Workup revealed multiple contrast enhancing lesions throughout the neuroaxis concerning for hemangioblastoma, with the largest cystic mass within the quadrigeminal cistern causing brainstem compression and hydrocephalus. The patient experienced an acute neurologic decompensation likely due to brainstem compression and hydrocephalus, which was temporized by cyst drainage and endoscopic third ventriculostomy. After neurological stabilization and Von Hippel Lindau disease workup, she underwent a suboccipital craniotomy and resection of the hemangioblastoma via a transcystic approach. Intraoperatively, the trochlear nerve was identified and preserved. Conclusion: Operative approaches to the quadrigeminal cistern typically include the infratentorial supracerebellar approach and the occipital transtentorial approach. Here, we describe a safe and efficacious transcystic approach to a quadrigeminal cistern hemangioblastoma.