Neuropsychological improvement after posterior fossa arachnoid cyst drainage.
OBJECTIVE
Posterior fossa arachnoid cysts (PFAC) are mostly considered as benign lesions of the cerebellum. Although many studies have shown the major role of the cerebellum in modulating movement, language, cognition, and social interaction, there are few studies on the cognitive impact and surgical decompression of PFAC.


METHODS
We present the cases of two brothers successively diagnosed with PFAC and neuropsychological delay. After multidisciplinary discussion with the boys' parents, it was decided to drain these lesions. Clinical signs, cerebral images, and neuropsychological status were assessed on admission and then 1 and 3 years after surgery.


RESULTS
At presentation, both children had mild cerebellar signs, associated with cognitive and visual-motor impairments and academic regression. CT scans revealed retrovermian cysts, which were shunted. Post-operatively, both brothers demonstrated improved visual-motor skills and behavior. At follow-up, we observed disappearance of dysarthria and academic delay and significant improvement in cognition especially at the intelligence scale and in language. Fine motor skills had improved but remained slower than the average and writing skills appeared limited.


CONCLUSIONS
Except for PFAC which impair cerebrospinal fluid circulation or which are responsible for a significant mass effect, most PFAC are usually considered as "asymptomatic" and do not require surgical treatment. The two cases reported herein suggest that these lesions might be responsible for some associated but potentially reversible neuropsychological impairment. In the future, clinical assessment should include neuropsychological evaluation to help inform decision for surgical decompression in these children with PFAC.
Laboratory of Memory and Cognition, Institute of Psychology, University Paris Descartes, Sorbonne Paris Cité, Paris, France.|CESP, University Paris-Sud, UVSQ, INSERM 1018, University Paris-Saclay, Villejuif, France.|Department of Neurosurgery, Necker University Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Cuny
Department of Neurosurgery, Necker University Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Pallone
Department of Neurosurgery, Necker University Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Piana
Department of Neuroradiology, Necker University Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Boddaert
Department of Neurosurgery, Necker University Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Sainte-Rose
CESP, University Paris-Sud, UVSQ, INSERM 1018, University Paris-Saclay, Villejuif, France.|Department of Child-psychiatry, IMAGINE Institute, Necker University Hospital and Faculty of Medicine, University Paris Descartes, Sorbonne Paris Cité, Paris, France.|Department of Pediatrics, Child development, Cochin-Port Royal University Hospitals, AP-HP, Paris, France.
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Vaivre-Douret
Laboratory of Memory and Cognition, Institute of Psychology, University Paris Descartes, Sorbonne Paris Cité, Paris, France.|Inserm UMR-S894, Center of Psychiatry and Neurosciences, Paris, France.|University Institute of France, Paris, France.
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Piolino
Department of Neurosurgery, Necker University Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France. stephanie.puget@gmail.com.
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http://orcid.org/0000-0002-4957-0835
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Puget
D016080:Arachnoid Cysts / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D019299:Decompression, Surgical; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D035781:Siblings
Arachnoid cyst; Children; Cognition; Motor skill; Posterior fossa