Clinical significance of cognitive function assessment in selecting treatment strategies for children with middle cranial fossa arachnoid cyst

Abstract

Objective To explore the effect of middle cranial fossa arachnoid cyst on cognitive function in children and to examine the clinical significance of cognitive function assessment in selecting treatment strategies. Methods A total of 42 cases with middle cranial fossa arachnoid cysts (cyst group) were analyzed from January 2015 to January 2018.Among them, 22 children underwent cyst-subarachnoid fistulization (operative group) while another 20 children's parents refused operation and requested conservative follow-up observations (conservative observation group). At the same time, 20 healthy children with the same age were selected as control group.No significant differences existed in age, gender, parental education level or other aspects between normal control and cyst groups.Wechsler Children's Intelligence Scale was employed for quantifying all children and verbal IQ (VIQ), performance IQ (PIQ) and full IQ (FIQ) were evaluated for conducting statistical analysis of cognitive function scores of each group.Cognitive function of each child was assessed before and 6 months after operation in operative group while conservative observation group was assessed immediately and 6 months later.All cases were confirmed without communication with subarachnoid space by phase contrast cine magnetic resonance imaging (MRI). All parents of participating children signed a form of informed consent. Results The values of VIQ, PIQ and FIQ of cyst group were 90.00±10.35, 94.05±10.04 and 91.79±9.80 respectively and were 101.4±7.87, 105.6±7.21 and 103.6±7.61 in control group respectively.There were significant inter-group differences (P=0.0001). The initial values of VIQ, PIQ and FIQ were 89.41±11.88, 94.41±10.60 and 91.41±11.26 in operative group and 90.65±8.62, 93.65±9.64 and 92.20±8.19 in conservative observation group respectively.No significant inter-group difference existed in VIQ, PIQ and FIQ (P>0.05). However, significant differences existed in VIQ, PIQ and FIQ in operative group preoperative and postoperatively (6 months post-operation). The postoperative values of VIQ, PIQ and FIQ were 96.82±10.70, 99.82±6.43, 99.45±7.66 respectively.In addition, VIQ, PIQ and FIQ in operative group at 6 months post-operation were significantly different from those in conservative observation group at 6 months (90.00±9.68, 92.80±9.64 & 91.75±8.56 respectively). There was statistical significance (P<0.05). Conclusions Cognitive function may be impaired by middle cranial fossa arachnoid cyst in children and it appears to be improved by cyst-subarachnoid fistulization.Preoperative assessment of cognitive function guides the selection of treatment strategies for arachnoid cyst. Key words: Cranial fossa, middle; Arachnoid cysts; Cognition disorders