• Katsuyoshi Miyashita, Nozomu Oikawa, Masaaki Kobayashi, Yasuhiro Aida, Tomohiro Kitabayashi, Yu Shimizu, and Yasuo Tohma.
• Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan. Electronic address: kmiya0810@gmail.com.
• World Neurosurg. 2020 Nov 1; 143: 28-32.

BackgroundIntracranial endodermal cysts are congenital lesions that generally develop in the cerebellopontine angle and ventral brainstem of the posterior fossa, whereas endodermal cysts in the quadrigeminal cistern are very rare. We report a rare case of an endodermal cyst in the quadrigeminal cistern with a non-enhancing nodule that developed in patient over 80 years of age.Case DescriptionAn 85-year-old man presented to our hospital with progressing gait disturbance and urinary incontinence. Preoperative images showed a cystic mass lesion with a nodule in the quadrigeminal cistern and hydrocephalus. There was no enhanced portion in the lesion, and the intensity of the cyst on magnetic resonance imaging revealed a high protein concentration. Subtotal resection was performed due to the adhesion of the cyst to the brainstem. It was diagnosed as an endodermal cyst. The postoperative course was uneventful, and hydrocephalus improved.ConclusionsThis is a rare case of an intracranial endodermal cyst in terms of location and age of onset compared with previous reports. This case demonstrates that endodermal cysts should be considered as a differential diagnosis for lesions in the quadrigeminal cistern with high protein concentration in the cyst and nodule representing chronic inflammation, regardless of enhancing effects.Copyright © 2020 Elsevier Inc. All rights reserved.

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