Surgical treatment for arachnoid cysts in adults: Clinical, radiological, neurocognitive and patient-reported outcomes.

INTRODUCTION

Intracranial arachnoid cysts (AC) are usually incidental findings, most often managed conservatively. Evidence of the effectiveness of surgical management in symptomatic patients is limited.

RESEARCH QUESTION: This case series evaluates clinical, radiological, neurocognitive, and patient-reported outcomes (PROMs) of surgically treated AC patients.

METHODS

Retrospective case series of surgically treated adult AC patients between 2010 and 2023. The primary outcome was improvement of presenting symptoms. Secondary outcomes included cyst volume, neurocognitive outcomes, revision rates, PROMs, and morbidity.

DISCUSSION: Between 2010 and 2023, 2537 AC were radiologically diagnosed at the University Hospital Basel, 18 patients (0.71%) underwent surgical treatment. Mean age was 51 ± 16 years. Cyst locations included convexity (44.4%), retrocerebellar (22.2%), middle fossa (16.7%), cerebellopontine angle (5.6%), and quadrigeminal cistern (5.6%). Common presenting symptoms were headache (66.7%), cognitive deficits (33.3%) and nausea (33.3%). Surgical techniques included endoscopic fenestration (77.8%), microsurgical fenestration (16.7%), and cystoperitoneal shunting (5.6%). During a mean follow-up of 2.9 ± 2.4 years, mean cyst volume decreased by 44.5 ± 30.4%. Clinical improvement was observed in 17 (94.4%) patients. Four (22.2%) patients underwent neuropsychological examinations pre- and post-surgery, showing neurocognitive deficits in the functional domains of memory (100%), concentration (75%), and executive function (50%), all of which improved postoperatively. Three (16.7%) patients required revision surgery due to ventriculitis, hydrocephalus, or insufficient fenestration. Patient satisfaction was high, with 88.9% of patients recommending surgery. No mortality occurred.

CONCLUSION

Surgical treatment of well-selected AC patients appears to be effective, resulting in improvements in symptoms and neurocognition, with low morbidity rates.