RESUMEN

BACKGROUND: There is no previous prospective study on the outcome of surgical decompression of intracranial arachnoid cysts (AC). OBJECTIVE: To investigate if surgical fenestration for AC leads to change in patients' health-related quality of life. METHODS: Prospective study including 76 adult patients operated for AC. Patients responded to Short Form-36 and Glasgow Benefit Inventory quality of life questionnaires, and to visual analogue scales, assessing headache and dizziness pre- and postoperatively. Patient scores were compared with those of a large sample of healthy individuals. RESULTS: Preoperatively, 84.2% of the patients experienced headache and 70.1% dizziness. Mean pre- versus postoperative Visual Analogue Scale scores for headache and dizziness dropped from 45.6 to 25.7 and from 35.2 to 12.2, respectively. Preoperative Short Form-36 scores were significantly below age norms in all subscales, but improved after surgery into normal range in 7 out of 8 subscales for middle-aged and older patients. Younger patients' scores remained lower than age norm in 6 out of 8 subscales. A significant postoperative improvement was seen in 3 out of 4 Glasgow Benefit Inventory subscales. Improvement in headache and/or dizziness, but not preoperative cyst size or reduction in cyst volume, correlated with improvement in 6 out of 8 Short Form-36 subscales and 3 out of 4 Glasgow Benefit Inventory subscales. Only 1 patient experienced a severe complication causing permanent invalidity. CONCLUSION: Surgery for AC can be performed with a fairly low risk of complications and yields significant improvement in quality of life correlated to postoperative improvement in headache and dizziness. These findings may justify a more liberal approach to surgical treatment for AC.

Asunto(s)

Quistes Aracnoideos/psicología , Quistes Aracnoideos/cirugía , Descompresión Quirúrgica/métodos , Calidad de Vida , Adulto , Descompresión Quirúrgica/efectos adversos , Mareo/etiología , Mareo/cirugía , Femenino , Estudios de Seguimiento , Escala de Consecuencias de Glasgow , Cefalea/etiología , Cefalea/cirugía , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

BACKGROUND: Temporal arachnoid cysts have been shown to interfere with the function of nervous structures, both cerebral cortex and cranial nerves. METHODS AND RESULTS: In this case report we describe a boy with a left temporal arachnoid cyst with a sudden onset of visual impairment 4 days after a mild trauma to the head. A perimetry test revealed a complete nasal hemianopia of the left eye, which normalized rapidly after an emergency craniotomy with cyst fenestration 3 hours after the patient experienced the reduced vision. CONCLUSIONS: The observed, reversible effect on vision is most probably caused by pressure exerted by the medial part of the cyst on the left optic nerve. We believe this is the first time such a case has been described.

Asunto(s)

Accidentes por Caídas , Quistes Aracnoideos/complicaciones , Traumatismos Cerrados de la Cabeza/complicaciones , Hemianopsia/etiología , Lóbulo Temporal/patología , Adolescente , Quistes Aracnoideos/cirugía , Hemianopsia/cirugía , Humanos , Masculino , Lóbulo Temporal/cirugía , Resultado del Tratamiento

RESUMEN

BACKGROUND: Arachnoid cyst (AC) fluid has not previously been compared with cerebrospinal fluid (CSF) from the same patient. ACs are commonly referred to as containing "CSF-like fluid". The objective of this study was to characterize AC fluid by clinical chemistry and to compare AC fluid to CSF drawn from the same patient. Such comparative analysis can shed further light on the mechanisms for filling and sustaining of ACs. METHODS: Cyst fluid from 15 adult patients with unilateral temporal AC (9 female, 6 male, age 22-77y) was compared with CSF from the same patients by clinical chemical analysis. RESULTS: AC fluid and CSF had the same osmolarity. There were no significant differences in the concentrations of sodium, potassium, chloride, calcium, magnesium or glucose. We found significant elevated concentration of phosphate in AC fluid (0.39 versus 0.35 mmol/L in CSF; p = 0.02), and significantly reduced concentrations of total protein (0.30 versus 0.41 g/L; p = 0.004), of ferritin (7.8 versus 25.5 ug/L; p = 0.001) and of lactate dehydrogenase (17.9 versus 35.6 U/L; p = 0.002) in AC fluid relative to CSF. CONCLUSIONS: AC fluid is not identical to CSF. The differential composition of AC fluid relative to CSF supports secretion or active transport as the mechanism underlying cyst filling. Oncotic pressure gradients or slit-valves as mechanisms for generating fluid in temporal ACs are not supported by these results.