1
|
Akalan N. Article by Adolfsson et al. "Cognition in children with arachnoid cysts - A five-year follow-up after microneurosurgical fenestration". Acta Neurochir (Wien) 2024; 166:222. [PMID: 38787461 DOI: 10.1007/s00701-024-06123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Nejat Akalan
- Department of Neurosurgery, Medipol University, Istanbul, Turkey.
| |
Collapse
|
2
|
Schmutzer-Sondergeld M, Gencer A, Niedermeyer S, Quach S, Stoecklein VM, Teske N, Schichor C, Terpolilli NA, Kunz M, Thon N. Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults. Acta Neurochir (Wien) 2024; 166:39. [PMID: 38280116 PMCID: PMC10821836 DOI: 10.1007/s00701-024-05950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/30/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE The best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for recurrence after surgical treatment, focusing on microscopic/endoscopic approaches as compared to minimally invasive stereotactic procedures in children and adults. METHODS In our single-institution retrospective database, we identified all patients treated surgically for newly diagnosed CAC between 2000 and 2022. Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years. Treatment decisions in favor of ME vs. STX were made by interdisciplinary consensus. The primary study endpoint was time to CAC recurrence (TTR). Secondary endpoints were outcome metrics including clinical symptoms and MR-morphological analyses. Data analysis included subdivision of the total cohort into three distinct age groups (AG1, < 6 years; AG2, 6-18 years; AG3, ≥ 18 years). RESULTS Sixty-two patients (median age 26.5 years, range 0-82 years) were analyzed. AG1 included 15, AG2 10, and AG3 37 patients, respectively. The main presenting symptoms were headache and vertigo. In AG1 hygromas, an increase in head circumference and thinning of cranial calvaria were most frequent. Thirty-five patients underwent ME and 27 STX, respectively; frequency did not differ between AGs. There were two (22.2%) periprocedural venous complications in infants (4- and 10-month-old) during an attempt at prepontine fenestration of a complex CAC, one with fatal outcome in a 10-month-old boy. Other complications included postoperative bleeding (2, 22.2%), CSF leaks (4, 44.4%), and meningitis (1, 11.1%). Overall, clinical improvement and significant volume reduction (p = 0.008) were seen in all other patients; this did not differ between AGs. Median follow-up for all patients was 25.4 months (range, 3.1-87.1 months). Recurrent cysts were seen in 16.1%, independent of surgical procedure used (p = 0.7). In cases of recurrence, TTR was 7.9 ± 12.7 months. Preoperative ventricular expansion (p = 0.03), paresis (p = 0.008), and age under 6 years (p = 0.03) were significant risk factors for CAC recurrence in multivariate analysis. CONCLUSIONS In patients suffering from CAC, both ME and STX can improve clinical symptoms at low procedural risk, with equal extent of CAC volume reduction. However, in infants and young children, CAC are more often associated with severe clinical symptoms, stereotactic procedures have limited use, and microsurgery in the posterior fossa may bear the risk of severe venous bleeding.
Collapse
Affiliation(s)
| | - Aylin Gencer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Sebastian Niedermeyer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nicole Angela Terpolilli
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
3
|
Cuny ML, Vaivre-Douret L, Piana H, Blauwblomme T, Beccaria K, Paternoster G, Bourgeois M, James S, Zerah M, Prodhomme J, Esnault E, Cozzo M, Trousson C, Navarro B, Stricker S, Boddaert N, Sainte-Rose C, Piolino P, Puget S. Temporosylvian arachnoid cysts in children. Part 1: Cognitive profile of children with a temporal cyst and impact of the cyst in daily life. A prospective study in 100 consecutive children. J Neurosurg Pediatr 2022; 30:138-149. [PMID: 35594888 DOI: 10.3171/2021.11.peds21203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to determine the cognitive profile of children with a temporal arachnoid cyst (TAC) and its impact on daily life. METHODS The authors prospectively analyzed the cognitive and psychological profiles of 100 consecutive children relative to age and cyst characteristics (side, cyst size, and cyst shape: convex or nonconvex) and their outcome 4 years later. RESULTS Mean IQs were normal but with high heterogeneity on Full Scale IQ (FSIQ; range 59-150); 29% of children had at least one Wechsler index below the norm, in particular, Processing Speed and Working Memory Indexes. Impairments were observed in language for 31% of children, as well as in verbal memory (28%), visual memory (23%), executive function (21%), and visual attention (24%). Half of the children (50%) needed rehabilitation for learning difficulties, and 26% had academic difficulties. The parental questionnaire BRIEF (Behavior Rating Inventory of Executive Function) revealed significant executive dysfunctions in daily life for 22% of the children. One-third of the patients (34%) required psychotherapy for anxiety or social disorders, with higher rates in patients with a right-sided cyst and older children. Cyst size had very little neuropsychological impact. Convex cysts were significantly associated with worse performance than nonconvex cysts on all Wechsler indexes and FSIQ, and in language, verbal memory, attention, and visuospatial skills. Children with a convex cyst had significantly more executive and behavior difficulties in daily life and more psychotherapy than other children. The effect of cyst shape was independent of Galassi type and cyst side. Children with a ruptured cyst or an incidentally discovered cyst usually had a good cognitive level. Four years later, children without initial disorders remained stable, whereas those with difficulties who did not undergo surgery needed more rehabilitation and school adaptations. CONCLUSIONS This large cohort study revealed a varied profile of children with a TAC: at initial assessment, 50% had neuropsychological difficulties and needed rehabilitation and/or psychotherapy for learning or behavior difficulties, and 50% had no difficulties, which may explain the debate about this pathology. Patients with neuropsychological difficulties had a heterogeneous profile with normal intelligence but selective cognitive and/or behavior disorders that may have a long-term impact on their quality of life, particularly those with a right-sided cyst. A neuropsychological evaluation is not always necessary for a cyst discovered incidentally, but early evaluation is essential in patients with academic, learning, or psychological disorders. When assessment shows selective disorders presumably linked to cyst location, surgery may be considered, particularly for convex cysts, as this study revealed more effects in association with cyst shape than with cyst size and significantly poorer performance with a convex cyst.
Collapse
Affiliation(s)
- Marie-Laure Cuny
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 2INSERM UMR 1018-CESP, Universités Paris-Saclay, UVSQ, Villejuif, France
- 5Laboratoire Mémoire, Cerveau et Cognition, Institut de Psychologie, Université de Paris; INSERM UMR S894, Paris, France; and
| | - Laurence Vaivre-Douret
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 2INSERM UMR 1018-CESP, Universités Paris-Saclay, UVSQ, Villejuif, France
- 3Faculté de Médecine, Université de Paris, France
- 4Institut universitaire de France, Paris, France
| | - Hélène Piana
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Thomas Blauwblomme
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | - Kévin Beccaria
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | | | - Marie Bourgeois
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Syril James
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Michel Zerah
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | - Julie Prodhomme
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Eglantine Esnault
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Mathilde Cozzo
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Clémence Trousson
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Béatrice Navarro
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Sarah Stricker
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Nathalie Boddaert
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | - Christian Sainte-Rose
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
- 6Service de Neurochirurgie, Centre Hospitalier Universitaire de Fort de France, Université des Antilles, Fort-de-France, Martinique
| | - Pascale Piolino
- 4Institut universitaire de France, Paris, France
- 5Laboratoire Mémoire, Cerveau et Cognition, Institut de Psychologie, Université de Paris; INSERM UMR S894, Paris, France; and
| | - Stephanie Puget
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
- 6Service de Neurochirurgie, Centre Hospitalier Universitaire de Fort de France, Université des Antilles, Fort-de-France, Martinique
| |
Collapse
|
4
|
Steyn PJ, Van den Heuvel LL. Cut it out or wait it out? Case series of middle fossa arachnoid cysts presenting with psychiatric symptoms and a discussion of the ethics of neurosurgical management. Gen Psychiatr 2022; 34:e100523. [PMID: 34970637 PMCID: PMC8685962 DOI: 10.1136/gpsych-2021-100523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
Arachnoid cysts have been linked to neuropsychiatric morbidity. We describe two patients presenting with dissociative and manic symptoms believed to be associated with middle fossa arachnoid cysts. They were managed medically and remitted eventually, but symptoms were resistant. We briefly review the literature to discuss mechanisms by which cysts could cause symptoms and consider whether neurosurgical management would be appropriate. Although neurosurgery can be considered, its role is currently limited by practical and ethical considerations.
Collapse
Affiliation(s)
- Petrus Johannes Steyn
- Psychiatry, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | | |
Collapse
|
5
|
Guell X, Anteraper SA, Ghosh SS, Gabrieli JDE, Schmahmann JD. Neurodevelopmental and Psychiatric Symptoms in Patients with a Cyst Compressing the Cerebellum: an Ongoing Enigma. THE CEREBELLUM 2020; 19:16-29. [PMID: 31321675 DOI: 10.1007/s12311-019-01050-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient diagnosed with developmental delay, intellectual disability, and autistic and obsessive-compulsive symptoms was found to have a posterior fossa arachnoid cyst (PFAC) compressing the cerebellum. The patient was referred to our Ataxia Unit for consideration of surgical drainage of the cyst to improve his clinical constellation. This scenario led to an in-depth analysis including a literature review, functional resting-state MRI analysis of our patient compared to a group of controls, and genetic testing. While it is reasonable to consider that there may be a causal relationship between PFAC and neurodevelopmental or psychiatric symptoms in some patients, there is also a nontrivial prevalence of PFAC in the asymptomatic population and a significant possibility that many PFAC are incidental findings in the context of primary cognitive or psychiatric symptoms. Our functional MRI analysis is the first to examine brain function, and to report cerebellar dysfunction, in a patient presenting with cognitive/psychiatric symptoms found to have a structural abnormality compressing the cerebellum. These neuroimaging findings are inherently limited due to their correlational nature but provide unprecedented evidence suggesting that cerebellar compression may be associated with cerebellar dysfunction. Exome gene sequencing revealed additional etiological possibilities, highlighting the complexity of this field of cerebellar clinical and scientific practice. Our findings and discussion may guide future investigations addressing an important knowledge gap-namely, is there a link between cerebellar compression (including arachnoid cysts and possibly other forms of cerebellar compression such as Chiari malformation), cerebellar dysfunction (including fMRI abnormalities reported here), and neuropsychiatric symptoms?
Collapse
Affiliation(s)
- Xavier Guell
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Cambridge, MA, USA. .,Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sheeba A Anteraper
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, Boston, MA, USA.,PEN Laboratory, Northeastern University, Boston, MA, USA
| | - Satrajit S Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - John D E Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeremy D Schmahmann
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Ataxia Unit, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
de Oliveira Filho ÍT, Romero PC, Fontoura EAF, de Oliveira SD, Botelho RV. Symptomatic foramen of Magendie arachnoid cyst in an elderly patient: The second case report in the literature. Surg Neurol Int 2019; 10:189. [PMID: 31637090 PMCID: PMC6778334 DOI: 10.25259/sni_380_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022] Open
Abstract
Background Arachnoid cysts are benign extra-axial lesions corresponding to 1% of intracranial expansive lesions. They are usually incidental findings in asymptomatic patients. Most cases are congenital, and when symptomatic are diagnosed in childhood or adolescence. Symptomatic arachnoids cyst in elderly patients is very rare. This report documents the second case in the literature of a symptomatic elderly patient with an arachnoid cyst located in the foramen of Magendie. Case Description A 68-year-old male had weakness in the lower limbs, imbalance, and gait disturbance for 3 years, associated with frequent falls. The patient complained of paresthesia in the upper right limb and right hemiface. An magnetic resonance imaging showed a massive cystic lesion in the posterior fossa in the foramen of Magendie. A median suboccipital craniectomy was performed, and the cyst was removed. Conclusion This case report adds to the literature the second case of a patient with a symptomatic arachnoid cyst in the posterior fossa successfully treated by surgery.
Collapse
|
7
|
Gjerde PB, Litleskare S, Lura NG, Tangen T, Helland CA, Wester K. Anxiety and Depression in Patients with Intracranial Arachnoid Cysts-A Prospective Study. World Neurosurg 2019; 132:e645-e653. [PMID: 31442638 DOI: 10.1016/j.wneu.2019.08.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Arachnoid cysts yield cognitive deficits that are normalized after surgical cyst decompression. OBJECTIVE The present study aimed to investigate whether arachnoid cysts also affect symptoms of anxiety and depression, and if surgical cyst decompression leads to reduction of these symptoms. METHODS Twenty-two adult patients (13 men and 9 women) with symptomatic temporal or frontal cysts were included in this questionnaire (Hospital Anxiety and Depression Scale [HADS])-based prospective study. The mean time between answering the preoperative questionnaire and surgery was 37 days. The patients answered the same HADS questionnaire 3-6 months postoperatively. RESULTS Preoperatively, both patients with frontal (N = 4) and patients with temporal (N = 18) cyst had higher mean HADS anxiety scores than those found in the general population. For patients with temporal cyst, there was a significant or near-significant difference in anxiety and depression scores and the combined scores between those with right-sided cysts and those with left-sided cysts. Postoperatively, the HADS scores normalized and were no longer different from those of the general population. The difference in scores between patients with right and left temporal cyst also disappeared. CONCLUSIONS Patients with arachnoid cyst have higher levels of anxiety and depression than do the general population and these scores were normalized after decompressive cyst surgery. We further found a hemispheric asymmetry: patients with a right temporal cyst showed higher anxiety, depression, and combined scores than did patients with a left temporal cyst. Also, this disparity normalized after cyst decompression. Thus, arachnoid cysts seem to affect not only cognition but also the level of affective symptoms.
Collapse
Affiliation(s)
- Priyanthi B Gjerde
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research (NORMENT) and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Medicine K2, University of Bergen, Bergen, Norway
| | - Sverre Litleskare
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Njål Gjærde Lura
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Tone Tangen
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Section of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Knut Wester
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department Neurosurgery, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
8
|
Lee SH, Park YS, Nam TK, Kwon JT. Psychopathological Influence of Middle Fossa Arachnoid Cysts in Young Men: Analysis of Korean Conscription Data. World Neurosurg 2019; 122:e530-e539. [PMID: 30889776 DOI: 10.1016/j.wneu.2018.10.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND A few reported studies have documented psychotic syndromes secondary to a middle fossa arachnoid cyst (AC). However, the association between middle fossa ACs and psychopathological symptoms remains to be determined. The present study investigated the psychopathological effects of middle fossa ACs in young men. METHODS We reviewed military personal inventory test profiles and baseline demographic data of 19-year-old conscription examinees from February 2013 to December 2016. In total, 132 examinees with middle fossa ACs and 350 examinees with normal findings were enrolled in the present study. Two separate comparisons were performed. First, we compared the middle fossa AC group with the control group. Second, the middle fossa AC group was divided into 2 groups according to cyst size and compared with the control group. RESULTS Faking bad response behavior, infrequency, inconsistency, depression, schizophrenia, paranoia, and personality disorder cluster A scales were significantly associated with the presence of a middle fossa AC. Abnormal responses to the military personal inventory were significantly and positively correlated with cyst size. The prediction rate to show abnormal psychological results with the presence of an AC was estimated to be 60.7%-68.8%. CONCLUSIONS The presence of ACs and cyst size were associated with psychopathology in this select group of young men. The size-dependent psychopathological effects of ACs appear to result from a local mass effect on the brain.
Collapse
Affiliation(s)
- Shin-Heon Lee
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yong-Sook Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
| | - Taek-Kyun Nam
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| |
Collapse
|
9
|
A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults. World Neurosurg 2019; 123:e259-e272. [DOI: 10.1016/j.wneu.2018.11.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
|
10
|
Schertz M, Constantini S, Eshel R, Sela AH, Roth J, Fattal-Valevski A. Neurodevelopmental outcomes in children with large temporal arachnoid cysts. J Neurosurg Pediatr 2018. [PMID: 29521605 DOI: 10.3171/2017.11.peds17490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Management of children with large temporal arachnoid cysts (TACs) remains controversial, with limited data available on their neurodevelopmental outcome. The aim of this study was to examine neurodevelopmental outcomes in children with large TACs. METHODS In this medical center-based cohort study, 25 patients (19 males) who were diagnosed in childhood with large TACs (9 patients [36%] with a Galassi type II and 16 patients [64%] with a Galassi type III TAC) were examined. The mean ± SD age at assessment was 11.1 ± 5.6 years (range 2.7-22 years). Twelve patients (48%) had right-sided, 12 (48%) had left-sided, and 1 (4%) had bilateral cysts. Nine patients (36%) underwent surgery for the cyst. The siblings of 21 patients (84%) served as control participants. Neurodevelopmental function was assessed using the Adaptive Behavior Assessment System (ABAS), Vanderbilt Behavioral Rating Scale (VBRS), and Developmental Coordination Disorder Questionnaire (DCDQ), and quality of life was measured using the treatment-oriented screening questionnaire (TOSQ). The results of all instruments except for TOSQ were compared with those of the sibling control participants. RESULTS The mean ± SD ABAS score of the patients was 93.3 ± 20.09 compared with 98.3 ± 18.04 of the sibling control participants (p = 0.251). Regarding the incidence of poor outcome (ABAS score < 80), there was a trend for more patients with TAC to have poor outcome than the sibling controls (p = 0.058). Patients who underwent surgery scored significantly worse with regard to the VBRS total score compared with those who did not (p = 0.020), but not on ABAS, DCD, or TOSQ. The mean score of the cognitive and psychological items on TOSQ was lower than that for the physical items (p < 0.001). CONCLUSIONS Children with a large TAC performed similarly to their sibling control participants in neurodevelopmental function. However, a subgroup of those with cysts did have an increased risk for poor outcomes in general function. Neurodevelopmental assessment should be part of the management of all patients with TAC.
Collapse
Affiliation(s)
- Mitchell Schertz
- 1Child Development & Pediatric Neurology Service, Meuhedet-Northern Region, Haifa.,2Pediatric Neurology Unit and
| | - Shlomi Constantini
- 3Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv; and.,4Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Eshel
- 3Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv; and
| | - Adi Hannah Sela
- 2Pediatric Neurology Unit and.,4Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Roth
- 3Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv; and.,4Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- 2Pediatric Neurology Unit and.,4Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
11
|
Rabiei K, Hellström P, Högfeldt-Johansson M, Tisell M. Does subjective improvement in adults with intracranial arachnoid cysts justify surgical treatment? J Neurosurg 2018; 128:250-257. [DOI: 10.3171/2016.9.jns161139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESubjective 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.METHODSThe 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.RESULTSPatients 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.CONCLUSIONSThe results of this study speak against objectively verifiable improvement following surgical treatment in adults with intracranial arachnoid cysts.
Collapse
Affiliation(s)
- Katrin Rabiei
- 1Institute of Neuroscience and Physiology, Sahlgrenska Academy; and
- 2Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Hellström
- 1Institute of Neuroscience and Physiology, Sahlgrenska Academy; and
| | - Mats Högfeldt-Johansson
- 1Institute of Neuroscience and Physiology, Sahlgrenska Academy; and
- 2Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Tisell
- 1Institute of Neuroscience and Physiology, Sahlgrenska Academy; and
- 2Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
12
|
Mattei TA. Pediatric arachnoid cysts and subdural hygromas in early infancy: challenging the direction of the causality paradigm. Neurosurgery 2014; 74:E150-3. [PMID: 24193361 DOI: 10.1227/neu.0000000000000181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
13
|
Miyabe-Nishiwaki T, Kaneko T, Sakai T, Kaneko A, Watanabe A, Watanabe S, Maeda N, Kumazaki K, Suzuki J, Fujiwara R, Makishima H, Nishimura T, Hayashi M, Tomonaga M, Matsuzawa T, Mikami A. Intracranial arachnoid cysts in a chimpanzee (Pan troglodytes). Primates 2013; 55:7-12. [PMID: 24068629 DOI: 10.1007/s10329-013-0384-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Abstract
An intracranial arachnoid cyst was detected in a 32-year-old, 44.6-kg, female chimpanzee at the Primate Research Institute, Kyoto University. Magnetic resonance imaging (MRI) and computed tomography (CT) were performed and the cognitive studies in which she participated were reviewed. MRI revealed that the cyst was present in the chimpanzee's right occipital convexity, and was located in close proximity to the posterior horn of the right lateral ventricle without ventriculomegaly. CT confirmed the presence of the cyst and no apparent signs indicating previous skull fractures were found. The thickness of the mandible was asymmetrical, whereas the temporomandibular joints and dentition were symmetrical. She showed no abnormalities in various cognitive studies since she was 3 years old, except a different behavioural pattern during a recent study, indicating a possible visual field defect. Detailed cognitive studies, long-term observation of her physical condition and follow-up MRI will be continued.
Collapse
|
14
|
Özek MM, Urgun K. Neuroendoscopic Management of Suprasellar Arachnoid Cysts. World Neurosurg 2013; 79:S19.e13-8. [DOI: 10.1016/j.wneu.2012.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 02/02/2012] [Indexed: 11/25/2022]
|
15
|
Lee EJ, Ra YS. Clinical and neuroimaging outcomes of surgically treated intracranial cysts in 110 children. J Korean Neurosurg Soc 2012; 52:325-33. [PMID: 23133720 PMCID: PMC3488640 DOI: 10.3340/jkns.2012.52.4.325] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 08/14/2012] [Accepted: 10/04/2012] [Indexed: 11/27/2022] Open
Abstract
Objective The indications and optimal surgical treatments for intracranial cysts are controversial. In the present study, we describe long-term clinical and neuroimaging results of surgically treated intracranial cysts in children. The goal of this study is to contribute to the discussion of the debate. Methods This study included 110 pediatric patients that underwent surgeries to treat intracranial cysts. Endoscopic cyst fenestrations were performed in 71 cases, while craniotomies and cyst excisions (with or without fenestrations) were performed in 30 patients. Cystoperitoneal shunts were necessary for nine patients. Long-term results were retrospectively assessed with medical and neuroimaging records. Results Clinical and radiological improvement was reported in 87.3% and 92.8% of cases, respectively, after endoscopic neurosurgery, and in 93.3% and 100% using open microsurgery whereas 88.9% and 85.7% after shunt operation. There were no statistical differences in clinical outcomes (p=0.710) or volume reductions (p=0.177) among the different surgeries. There were no mortalities or permanent morbidities, but complications such as shunt malfunctions, infections, and subdural hematomas were observed in 56% of the patients that had shunt operations. A total of 13 patients (11.8%) underwent additional surgeries due to recurrences or treatment failures. The type of surgery performed did not influence the recurrence rate (p=0.662) or the failure rate (p=0.247). Conclusion Endoscopic neurosurgeries are less invasive than microsurgeries and are at least as effective as open surgeries. Thus, given the advantages and complications of these surgical techniques, we suggest that endoscopic fenestration should be the first treatment attempted in children with intracranial cysts.
Collapse
Affiliation(s)
- Eun-Jung Lee
- Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | | |
Collapse
|
16
|
Arachnoid cyst associated to spontaneous CSF fistula and massive pneumocephalus. Acta Neurochir (Wien) 2012; 154:1941-2. [PMID: 22878454 DOI: 10.1007/s00701-012-1465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
|
17
|
Talamonti G, D'Aliberti G, Picano M, Debernardi A, Collice M. Intracranial Cysts Containing Cerebrospinal Fluid-Like Fluid: Results of Endoscopic Neurosurgery in a Series of 64 Consecutive Cases. Neurosurgery 2011; 68:788-803; discussion 803. [DOI: 10.1227/neu.0b013e318207ac91] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Intracranial cysts containing cerebrospinal fluid (CSF) may be developmental or acquired.
OBJECTIVE:
To analyze the results of endoscopic neurosurgery in the management of intracranial CSF cysts.
METHODS:
In a 7-year period, 64 consecutive patients underwent endoscopic neurosurgery for CSF cysts. Group 1 consisted of 13 patients with acquired cysts; group 2 included 51 patients with developmental cysts. In all cases, the cyst walls were fenestrated through small burr holes with frameless guided operative endoscopes. Follow-up ranged from 1 to 6 years (mean, 3.4 years).
RESULTS:
There were no mortality and no permanent morbidity, apart from a patient (1.6%) who remained neurologically intact but required ventriculoperitoneal shunting because of intraoperative hemorrhage. The planned fenestrations could be performed in all patients except 2, owing to thick, opaque cyst walls. In group 1, 6 patients fully recovered and remained intact throughout the follow-up, whereas 7 improved but had various degrees of neurological disabilities that were related to their initial diseases. Radiological results were excellent in all cases. In group 2, there were 7 asymptomatic patients who remained unchanged and 44 “symptomatic” patients: 40 (91%) clinically improved, 4 (9%) remained unchanged, and none worsened. Cyst size decreased in 37 patients (74%) and remained unchanged in 13 (26%).
CONCLUSION:
In this series, patients of different ages, harboring cysts of various sizes and locations, could be satisfactorily treated with endoscopic neurosurgery.
Collapse
Affiliation(s)
| | | | - Marco Picano
- Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
| | | | - Massimo Collice
- Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
| |
Collapse
|
18
|
Amin OSM, Shwani SS. Asymptomatic supratentorial arachnoid cyst and symptomatic demyelination plaques: which one needs treatment? BMJ Case Rep 2010; 2010:2010/nov22_1/bcr0820103286. [PMID: 22797210 DOI: 10.1136/bcr.08.2010.3286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intracranial arachnoid cysts are rare but the widespread use of brain imaging has disclosed many asymptomatic cysts. The authors report the case of a 37-year-old woman who presented with features suggestive of relapsing-remitting multiple sclerosis (MS). Her brain MRI revealed a moderately large arachnoid cyst in the right frontal area in addition to the periventricular plaques of MS. The cyst was an incidental imaging finding and the patient was asymptomatic prior to the development of MS.
Collapse
|
19
|
Audiovestibular factors influencing quality of life in patients with conservatively managed sporadic vestibular schwannoma. Otol Neurotol 2010; 31:968-76. [PMID: 20684063 DOI: 10.1097/mao.0b013e3181e8c7cb] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To measure the health-related quality of life (QoL) of patients undergoing conservative management of a vestibular schwannoma and to identify audiovestibular factors that influence health-related QoL. STUDY DESIGN Cross-sectional case-control study. INTERVENTION Adult patients undergoing conservative management of a sporadic vestibular schwannoma were identified from a prospectively updated database. Each patient was asked to complete a series of questionnaires, including the Short Form 36 health-related QoL instrument, the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Dizziness Handicap Inventory. The QoL data obtained were compared with UK normal data. Multiple linear regression was performed to identify audiovestibular factors influencing QoL. PATIENTS Of 241 patients still undergoing conservative management, 165 completed the questionnaires. The mean age was 66.6 years. Mean duration of follow-up was 5.7 years. RESULTS Physical component summary scores were significantly lower than those of the normal population. Mental component summary scores were significantly above the normal population. Regression analysis showed that dizziness handicap score and age were strong predictors of physical component summary (both p < 0.0001). Dizziness handicap score and tinnitus handicap score were significant predictors of mental component summary (p = 0.0004 and p = 0.027 respectively). However, the model only explained a small amount of the data, suggesting that there may be other factors influencing QoL. CONCLUSION Dizziness is the most significant audiovestibular predictor of QoL in patients with vestibular schwannomas. Tinnitus also has an impact on mental QoL. Hearing loss does not seem to influence QoL. Other factors such as illness perception may have an important role to play in determining QoL.
Collapse
|
20
|
Torgersen J, Helland C, Flaatten H, Wester K. Reversible dyscognition in patients with a unilateral, middle fossa arachnoid cyst revealed by using a laptop based neuropsychological test battery (CANTAB). J Neurol 2010; 257:1909-16. [DOI: 10.1007/s00415-010-5634-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/08/2010] [Accepted: 06/11/2010] [Indexed: 01/26/2023]
|
21
|
de-Melo-Neto VL, Lopes FL, Magalhães FV, Domingues RC, Hallak JE, Crippa JA, Nardi AE. Anterior cingulate cortex activation as a trait of panic disorder in a patient with a temporal arachnoid cyst. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1565-7. [PMID: 19748541 DOI: 10.1016/j.pnpbp.2009.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/01/2009] [Accepted: 09/02/2009] [Indexed: 11/24/2022]
|
22
|
Park YS, Eom S, Shim KW, Kim DS. Neurocognitive and psychological profiles in pediatric arachnoid cyst. Childs Nerv Syst 2009; 25:1071-6. [PMID: 19357855 DOI: 10.1007/s00381-009-0872-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to investigate whether intracranial arachnoid cysts (AC) compromise neurocognitive function and psychological profiles in pediatric patients, depending on various clinical factors. METHODS We assessed neurocognitive functions and psychological tests in 35 AC patients and 35 healthy control subjects between October 2007 and April 2008. AC patients ranged in age from 3 to 15 (7.94 +/- 3.12) years old and control patients from 5 to 13 (8.84 +/- 2.17) years old. The location of the AC were temporal (n = 22), frontal (n = 6), suprasellar (n = 4), and posterior fossa (n = 3). Patients underwent neurocognitive and psychological assessments before surgery. To investigate which AC impair neurocognitive function and psychological profile, we assessed intelligence, memory, attention, executive function, behavioral problems, emotional distress, and parenting stress. RESULTS AC caused some demonstrated impairment by both neurocognitive function and psychological assessments. Left hemisphere AC tended to have more anxiety; mood changes can be detected depending on cyst grade. An incidental finding of AC after trauma is more intelligent, well-reserved executive function. Frontal locations tended to cause more anxiety than temporal locations. CONCLUSIONS Our results imply that intracranial AC impairs some neurocognitive and psychological functions. An incidental finding of AC after trauma was a more intelligent, well-reserved executive function. AC in the left hemisphere, frontal location tended to cause more anxiety. The AC itself did not cause differences in neurocognitive function from the control group. However, parenting stress in the AC group was much higher than in the control group.
Collapse
Affiliation(s)
- Young Seok Park
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemoon-gu, Seoul 120-752, Republic of Korea
| | | | | | | |
Collapse
|
23
|
Bucuk M, Tomic Z, Bralic M, Rudez J, Jurjevic A. A case with giant arachnoid cysts manifested as migraine. Wien Klin Wochenschr 2009; 120:665. [PMID: 19116706 DOI: 10.1007/s00508-008-1083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Intracranial arachnoid cysts – do they impair mental functions? J Neurol 2008; 255:1113-20. [DOI: 10.1007/s00415-008-0011-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 05/09/2008] [Accepted: 05/19/2008] [Indexed: 11/24/2022]
|