Neurodevelopmental outcomes in children with large temporal arachnoid cysts

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>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 &lt; 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 &lt; 0.001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>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.</jats:p></jats:sec>

Burr hole trephination in treatment of convexity arachnoid cyst presenting with headache and anxiety disorder: case report

“…On postoperative first day, her headache and anxiety disorder was completely relieved and CT of the brain scan showed a complete disappearance of the AC ( Occasionally, they are complicated by intracystic or subdural hemorrhage with/without history of preceding trauma (6,7). Clinically, ACs are generally detected incidentally and they are often considered silent, but the diagnosis itself can have a significant impact on patients and their families because of the co-existence of psychiatric and cognitive disorders with AC in some cases, as did in our patient (8)(9)(10).…”

Intracranial Arachnoid Cysts in Childhood: Pathogenesis, Clinical Features, and Management

“…[1,28] (Figure 3) Other locations are suprasellar, ventricular, or convexity cysts. [1,3,4,19,20,[29][30][31][32] The practical importance of location classification lies in the different symptomatological spectra and treatment possibilities, which will be discussed later. (Figure 4)…”

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

“…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.…”

“…In pediatric patients, disturbances in the development of speech and language functions, psychomotor developmental delays, and attention deficit disorders were found especially in ACs of the middle cranial fossa. 3,6,19,20,26 A few reports comparing the cognitive functioning of patients before and after neurosurgical treatment described an improvement of the cognitive function. [27][28][29][30][31][32][33] In clinical practice, the patients with AC referred to surgery had symptoms of intracranial hypertension and/or symptoms related compression of brain structures including the obstruction of the ventricular system.…”

“…[1][2][3]5,9,11,14,28 Factors supporting the indication for surgery are large size of the cyst (> 68 mm 3 ), younger age at time of diagnosis (< 4 years), and the location in the anterior cranial fossa and in the vicinity of the tectal plate. Less clear indications for surgery are nonspecific problems as learning impairments and defects of speech or cognitive functions 19,[27][28][29][30][31][32][33] It is especially problematic to define to what extent the cognitive deficits are actually related to the AC. Thus, prediction if the patient's mental health will improve after surgery is not possible.…”