AGR - 2 Colloid Cyst: Underrecognized Neuropsychological Sequalae of a Neurosurgical Diagnosis.

Abstract

Colloid cysts are a benign, fluid-filled collection often found in the rostral third ventricle at/near the foramen of Monro, accounting for 0.5-2% of all brain tumors. Modifying factors of neurocognition include: resultant hydrocephalus, mass effect, as well as size, location and laterality of cyst. The modality of neurosurgical intervention/approach also impacts the risk of post-operative neurocognitive morbidity. This grand rounds presentation reviews relevant literature - anchored by our own research - highlighting neuropsychological assessment considerations and possible interventional strategies in order to enhance outcomes in patients with colloid cyst. Neuropsychological test data evaluating 20 patients who underwent neuropsychological assessment pre- and post-endoscopic removal of a colloid cyst are discussed. Comprehensive testing included gold-standard metrics of attention, executive functioning, learning, memory, visuospatial abilities, language, motor, and mood. Neuroimaging data, surgical parameters and pre and post-neurosurgical neuropsychological test data are also presented on all patients. Additionally, a small subset of patients were evaluated post-computerized cognitive remediation to establish treatment efficacy. For each variable, a paired t-test was performed between the pre- and post-operative z-score. Only one sub-score evinced a statistically significant change post-operatively (p = 0.037), with Stroop Color-Word score improving from pre-surgical baseline. No other metric or analyzed sub-score reached statistical significance. Though obtained findings argue against post-operative declines, a variety of neuroanatomical, neurosurgical, neuropsychological, and behavioral factors underscore the need for a coordinated, multi-disciplinary approach to continuity of care in this patient population, as well as others with non-cancerous brain tumors and/or cysts.