Intracranial arachnoid cysts: impairment of higher cognitive functions and postoperative improvement

Priyanthi B Gjerde,Marit Schmid,Åsa Hammar,Knut Wester

doi:10.1186/1866-1955-5-21

Priyanthi B Gjerde, Marit Schmid + Show 2 more

Open Access

https://doi.org/10.1186/1866-1955-5-21

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Abstract

BackgroundIntracranial arachnoid cysts have been shown to yield cognitive impairment over a range of basic mental functions, and these functions normalize after surgical cyst decompression. We wanted to investigate whether such cysts may also impair executive cognitive functions, and whether surgical cyst decompression leads to an improvement.MethodsThis study included 22 patients with arachnoid cysts and 13 control patients scheduled for low back surgery. All subjects were tested with Delis-Kaplan Executive Function System (D-KEFS) tests, assessing executive function 1 day before surgery and a minimum of 3 months after surgery. The data were analyzed according to scaled score computations based on raw scores provided by D-KEFS, adjusted for age, gender, and educational norms.ResultsPreoperatively, the patients with cysts group performed worse than the control group in verbal knowledge, mental flexibility, inhibitory capacity, problem solving, and planning skills. Postoperatively, the patients with cysts group significantly improved performance and were no longer different from the control group in the following subtests: inhibition, inhibition/switching, letter fluency, category switching, and total switching accuracy. The patients with cysts group also significantly improved performance in color naming, category fluency, and in the Tower test, but nevertheless remained impaired at follow-up compared with the control group. The control group did not show a similar improvement, except for the Tower test. Cyst size or postoperative volume reduction did not correlate with cognitive performance or postoperative improvement. Patients with left-sided temporal cysts performed poorer than patients with right-sided cysts on a complex verbal task demanding mental flexibility.ConclusionsArachnoid cysts seem to impair not only basic cognition, but also executive functions. Most of this impairment appears to be reversible after surgical cyst decompression. These results may have implications for future preoperative considerations for patients with intracranial arachnoid cysts.

Highlights

Intracranial arachnoid cysts have been shown to yield cognitive impairment over a range of basic mental functions, and these functions normalize after surgical cyst decompression
Patients with intracranial arachnoid cysts may live their entire life without any overt symptoms from the cyst, even if the cyst is large, and cognition and neurological functions appear normal
The aim of this study is to investigate whether temporal arachnoid cysts may impair complex cognitive functions and, if so, whether surgical cyst decompression leads to an improvement

Summary

Introduction

Intracranial arachnoid cysts have been shown to yield cognitive impairment over a range of basic mental functions, and these functions normalize after surgical cyst decompression. Patients with intracranial arachnoid cysts may live their entire life without any overt symptoms from the cyst, even if the cyst is large, and cognition and neurological functions appear normal. This lack of dramatic symptoms most likely reflects the brain’s ability to compensate for the presence of a slowly growing or stable expansion, and by the fact that the cyst is already present from early childhood and may have influenced the volume and shaping of the skull, allowing space for the cyst [10]. There appears to be an association between the intracystic pressure and the strength of the reported symptoms [11]

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