Temporosylvian arachnoid cysts in children. Part 2: Postoperative neuropsychological and clinical improvement

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  • 1 Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France;
  • | 2 INSERM UMR 1018-CESP, Universités Paris-Saclay, UVSQ, Villejuif, France;
  • | 3 Faculté de Médecine, Université de Paris, France;
  • | 4 Institut universitaire de France, Paris, France;
  • | 5 Laboratoire Mémoire, Cerveau et Cognition, Institut de Psychologie, Université de Paris; INSERM UMR S894, Paris, France; and
  • | 6 Service de Neurochirurgie, Centre Hospitalier Universitaire de Fort de France, Université des Antilles, Fort-de-France, Martinique
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OBJECTIVE

The authors’ objective was to study clinical, imaging, and neuropsychological changes in children who underwent surgery for a temporal arachnoid cyst (TAC).

METHODS

Thirty-four children were prospectively assessed similarly at diagnosis and postoperatively (mean 14 months) with clinic visits, images, cognitive tests, and parental questionnaires on mood/behavior and executive functions. The scores were compared pre- and postoperatively for the entire cohort and individually. The scores of 25 children were also compared with a control group of 23 healthy age-matched children. Parents were administered an outcome questionnaire on average 4 years postoperatively.

RESULTS

The 34 children selected for surgery had signs of raised intracranial pressure (74%) and/or selective neuropsychological disorders presumably linked to cyst location (learning difficulties in 65%, cognitive difficulties in 56%, and mood/behavior difficulties in 47%). The majority of patients had a convex cyst (85%) and underwent microsurgical fenestration (85%). The TAC volume decreased ≥ 50% for 59% of children. On the Wechsler Intelligence Scale, the entire cohort significantly improved on Full Scale IQ and verbal and perceptual nonverbal indexes. Individually, nearly half of the children (47%) highly increased their scores (≥ 15 points) on at least one IQ index and 26% on at least two indexes. Language, working memory, episodic memory, and executive functions were also significantly improved. Improvements were more pronounced in patients with a preoperative heterogeneous profile with isolated lower scores and a left-sided cyst. Parental questionnaires showed reduction in anxiety, aggressiveness, social problems, and daily life executive disorders. Preschool-aged children improved significantly in language and verbal IQ, as did middle/high school–aged children in many domains. Individual analyses revealed improvement in 76% of cases. Cognitive scores were lower for patients preoperatively than for controls and were no longer significantly different postoperatively in verbal fluency, visual memory, and working memory. Four years later, 97% of parents described an improvement in their child, correlated with cognitive improvements.

CONCLUSIONS

Among children with a TAC, some have no clinical signs or neuropsychological difficulties, and others may show signs of raised intracranial pressure and/or specific neuropsychological disorders that impact daily life and require significant and long-lasting rehabilitation. In these cases, consideration may be given to surgical decompression. It is interesting to note that 76% of this surgically treated cohort improved regardless of the child’s age, particularly in patients with selective disorders and an impact on daily life. However, a larger number of children will need to be investigated before the true benefit of such treatment can be known.

ABBREVIATIONS

BRIEF = Behavior Rating Inventory of Executive Function; CBCL = Child Behavior Checklist; CDI = Children’s Depression Inventory; FSIQ = Full Scale IQ; ICP = intracranial pressure; NEPSY = A Developmental Neuropsychological Assessment; TAC = temporal arachnoid cyst; WISC-IV = Wechsler Intelligence Scale for Children–IV.

Images from Oushy et al. (pp 195–202).

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