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

Journal article
Authors Katrin Rabiei
Per Hellström
Mats Högfeldt Johansson
Magnus Tisell
Published in Journal of Neurosurgery
Volume 128
Issue 1
Pages 250-257
ISSN 0022-3085
Publication year 2018
Published at Institute of Neuroscience and Physiology
Pages 250-257
Language en
Links https://doi.org/10.3171/2016.9.JNS1...
Keywords Balance testing, Cyst volume, Intracranial arachnoid cysts, Neuropsychological testing, adult, anterior cingulate, aphasia, arachnoid cyst, Article, assessment of humans, balance impairment, bone graft, clinical evaluation, clinical examination, cognitive defect, controlled study, cranioplasty, differential diagnosis, dizziness, dorsolateral prefrontal cortex, epidural hematoma, Falls Efficacy Scale, female, follow up, grooved pegboard test, head injury, headache, human, hygroma, liquorrhea, major clinical study, male, meningitis, neuralgia, neuropsychological test, nuclear magnetic resonance imaging, outcome assessment, population research, posterior fossa, postoperative period, priority journal, prospective study, reoperation, Rey auditory verbal learning test, Rey Osterrieth complex figure test, Romberg test, seizure, Stroop test, subdural empyema, subdural hematoma, temporal lobe, visual disorder, volumetry
Subject categories Neurosurgery

Abstract

OBJECTIVE Subjective improvement of patients who have undergone surgery for intracranial arachnoid cysts has justifed 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 fgure, and Stroop tests. Balance tests included the extended Falls Effcacy 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 verifable improvement following surgical treatment in adults with intracranial arachnoid cysts. © AANS 2018.

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