Does subjective improvement in adults with intracranial arachnoid cysts justify surgical treatment?

Abstract

OBJECTIVE Subjective improvement of patients who have undergone surgery for intracranial arachnoid cysts has justified surgical treatment. The current study aimed to evaluate the outcome of surgical treatment for arachnoid cysts using standardized interviews and assessments of neuropsychological function and balance. The relationship between arachnoid cyst location, postoperative improvement, and arachnoid cyst volume was also examined. METHODS The authors performed a prospective, population-based study. One hundred nine patients underwent neurological, neuropsychological, and physiotherapeutic examinations. The arachnoid cysts were considered symptomatic in 75 patients, 53 of whom agreed to undergo surgery. In 32 patients, results of the differential diagnosis revealed that the symptoms were due to a different underlying condition and were unrelated to an arachnoid cyst. Neuropsychological testing included target reaction time, Grooved Pegboard, Rey Auditory Verbal Learning, Rey Osterrieth complex figure, and Stroop tests. Balance tests included the extended Falls Efficacy Scale, Romberg, and sharpened Romberg with open and closed eyes. The tests were repeated 5 months postoperatively. Cyst volume was pre- and postoperatively measured using OsiriX software. RESULTS Patients who underwent surgery did not have results on balance and neuropsychological tests that were different from patients who declined or had symptoms unrelated to the arachnoid cyst. Patients with a temporal arachnoid cyst performed within the normal range on the neuropsychological tests. Seventy-seven percent of the patients who underwent surgery reported improvement, yet there were no differences in test results before and after surgery. Arachnoid cysts in the temporal region and posterior fossa did not influence the preoperative results of neuropsychological and motor tests. The arachnoid cyst volume decreased postoperatively (p < 0.0001), but there was no relationship between volume reduction and clinical improvement. CONCLUSIONS The results of this study speak against objectively verifiable improvement following surgical treatment in adults with intracranial arachnoid cysts.

Giant arachnoid cyst in adult presented with secondary epileptiform activity

“…found no changes in surgically treated patients despite self-reported improvement. [ 8 ] Some authors recommend medical treatment for patients with headache or seizures. [ 9 ] The current case had been suspected symptomatic despite absence of raised ICP.…”

Acute communicating hydrocephalus after intracranial arachnoid cyst decompression: A report of two cases

“…[ 1 , 18 ] Rabiei et al ., however, failed to find a clear relationship between cyst reduction and improvement in clinical metrics including motor and neuropsychological tests. [ 22 ] This lack of consensus is important when considering surgical treatment, which is associated with an 18–21% rate of complications, though the endoscopic surgical approach may bear lower risk. [ 6 , 10 , 12 ]…”

Cognitive Impairment in Children with Arachnoid Cyst of Sylvian Fissure: Does it Justify the Neurosurgical Treatment?

“…Physicians often ask whether to qualify a patient with AC for surgery, and if so, on the basis of what criteria. 8,9,18,28,31,34,36 There is no doubt that symptomatic ACs should be treated surgically. However, should a reduced intellectual potential, problems at school, or a diminished psychomotor drive be criteria for indicating surgery?…”

“…However, more recent publications suggest an association between an AC and psychopathologic symptoms: Patients with ACs may experience cognitive deficits such as memory and attention functioning disorders, visuospatial disorders, and language impairments. 3,[17][18][19][20][21][22] Some authors also indicate a relationship between cysts and psychiatric disorders. [23][24][25] Most of these reports concern adult patients.…”