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  • Can Subjective Improvement of Patients Operated for Arachnoid Cysts Be Measured and Justify Surgical Treatment?

    Final Number:

    Katrin Rabiei MD, PhD, FEANS, MSc; Per Hellström; Mats Högfeldt; Magnus Tisell

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Patients with arachnoid cysts (AC) display various neurological symptoms. The most common symptoms of AC are frequent in general population and a causal relationship between symptoms and AC is debatable. Therefore treatment of AC remains controversial. The aim of this study was to evaluate symptoms of patients with AC using neuropsychological- and balance testing and to examine the correlation between cyst location and test results.

    Methods: 109 adult patients were included prospectively and consecutively in this study. All patients underwent neurological-, neuropsychological-, and physiotherapeutic examinations. AC was considered symptomatic in 75 and asymptomatic in 32. Fifty-three accepted surgical treatment and 22 declined. Neuropsychological testing included Rey Auditory Verbal Test, Stroop test, Grooved peg board and Target Reaction time. Balance tests included Romberg’s test, Backstrand, Dahlberg and Liljenas balance scale and Swedish version of Falls Efficacy Scale. Operated patients underwent the same test battery 4-6 months after surgery. Cyst volume was measured with OsiriX® software pre- and postoperatively. Long-term follow-up of the operated patients is performed 8.5 years (11.8-6.5) after the initial surgery through structured interviews.

    Results: Patients who accepted surgical treatment did not differ from the other two groups considering balance test and neuropsychological test results. Performance of patients with temporal cysts was in the normal range for test results of the neuropsychological tests. 77% of the operated patients reported improvement, yet there were no differences in test results of the operated patients before and after surgery. AC in temporal region and posterior fossa did not influence results of neuropsychological- and motor tests respectively. Cyst volume decreased postoperatively (<0,0001) yet there was no relation between cyst volume and clinical improvement. Preliminary results from the long-term follow up will be presented.

    Conclusions: Surgical treatment of AC in absence of hydrocephalus does not improve cognitive impairment or imbalance in spite of reported patient improvement. The results suggest a restrictive approach toward surgery for arachnoid cysts.

    Patient Care: Research on incidental findings being surgically treated based on subjective symptoms is of great importance because it emphasizes that symptoms are perhaps not related to this condition despite subjective reported improvement. This is of great importance considering the risk for complications that the surgical procedures have.

    Learning Objectives: Participants should be able to 1) understand the neuropsychological and balance tests involved 2) Based on the presented results, make their own conclusion regarding surgery for arachnoid cysts.


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