Intracranial arachnoid cysts: impairment of higher cognitive functions and postoperative improvement

Abstract

BackgroundIntracranial arachnoid cysts have been shown to yield cognitive impairment over a range of basic mental functions, and these functions normalize after surgical cyst decompression. We wanted to investigate whether such cysts may also impair executive cognitive functions, and whether surgical cyst decompression leads to an improvement.MethodsThis study included 22 patients with arachnoid cysts and 13 control patients scheduled for low back surgery. All subjects were tested with Delis-Kaplan Executive Function System (D-KEFS) tests, assessing executive function 1 day before surgery and a minimum of 3 months after surgery. The data were analyzed according to scaled score computations based on raw scores provided by D-KEFS, adjusted for age, gender, and educational norms.ResultsPreoperatively, the patients with cysts group performed worse than the control group in verbal knowledge, mental flexibility, inhibitory capacity, problem solving, and planning skills. Postoperatively, the patients with cysts group significantly improved performance and were no longer different from the control group in the following subtests: inhibition, inhibition/switching, letter fluency, category switching, and total switching accuracy. The patients with cysts group also significantly improved performance in color naming, category fluency, and in the Tower test, but nevertheless remained impaired at follow-up compared with the control group. The control group did not show a similar improvement, except for the Tower test. Cyst size or postoperative volume reduction did not correlate with cognitive performance or postoperative improvement. Patients with left-sided temporal cysts performed poorer than patients with right-sided cysts on a complex verbal task demanding mental flexibility.ConclusionsArachnoid cysts seem to impair not only basic cognition, but also executive functions. Most of this impairment appears to be reversible after surgical cyst decompression. These results may have implications for future preoperative considerations for patients with intracranial arachnoid cysts.

Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children

“…Wester et al proposed the possibility that the impairment of higher cognitive functions is reversible after surgical cyst decompression. 8,17 As described previously, it is unclear whether local compression of the underlying cerebral parenchyma by arachnoid cysts can have adverse effects on brain functions and development. Certainly, it is difficult to investigate the functional and developmental impairments caused by chronic local brain compression due to arachnoid cysts, but we can consider the potential of prophylactic treatment for large asymptomatic arachnoid cysts such as Galassi Type III lesions to protect the developing brain in pediatric patients.…”

Cognition in Children with Arachnoid Cysts

“…The studies that do report different aspects of cognitive functioning before and after neurosurgical intervention do seem to confirm that ACs may impair cognition and that the preoperative cognitive symptoms might be improved or even normalized following surgical decompression [6,18]. Visuospatial defects, impairment in executive function and memory have shown to be improved by surgery of temporal cysts in several case series [4,6,7].…”

“…The majority of individuals where ACs have been identified are male and the middle fossa is the most common location [3]. Temporal ACs have been linked to delayed psychomotor development, seizures, headache, hydrocephalus, and cranial deformation [4]. Additionally, in case series, temporal cysts have been associated with dizziness, decreased visuospatial orientation, imbalance, as well as impairment of higher cognitive functions such as memory [4][5][6][7].…”

“…Some studies claim that ACs are to be regarded as congenital findings that should not be surgically treated unless they cause severe symptoms [5]. While others suggest a 2 of 11 connection between temporal ACs and neuropsychiatric symptoms motivating surgical treatment to possibly alleviate these symptoms [4].…”

Disequilibrium in patients with posterior fossa arachnoid cysts

“…Temporal cysts may cause a variety of symptoms, most commonly headache, and surgical cyst decompression may decrease or eliminate these symptoms, as shown both in children and in adults . Temporal AC have also been demonstrated to yield dyscognition that appears to normalize after surgical cyst decompression .…”