Temporo-Sylvian Arachnoid Cysts in Children – Ongoing Debate on Management

Introduction: Arachnoid cysts occur as a result of disturbed splitting of arachnoid membranes during embryogenesis. The prevalence of these benign malformations is estimated at 0.2–1.1%. The sylvian fissure, where 50% of all cysts occur, is the most common localization. Most frequent symptoms of arachnoid cysts include: headache, seizures and sudden deterioration as a result of rupture. The majority of cases are asymptomatic and constitute incidental findings, which are therefore left untreated. However it has been suggested that temporo-sylvian cysts may have an impact on the neuropsychological development of children who are otherwise considered asymptomatic. It is thus of major interest to study possible early manifestations of temporo-sylvian arachnoid cysts to optimize early diagnosis and adequate management, especially the indication for surgery.

Methods: We will present case studies demonstrating the ongoing debate on the management of temporo-sylvian arachnoid cysts in children. We will discuss the literature review, on which the outlook of an ongoing study analyzing a total of 100 treated and untreated cases is based upon. Thereby we hope to show the importance of establishing a more profound understanding of possible early neuropsychological manifestations in children with temporo-sylvian cysts including cognitive and learning disorders.

Discussion: According to this year’s consensus conference of the ESPN (European Society of Pediatric Neurosurgery) on arachnoid cysts in children the best management of cysts located in the temporo-sylvian region remains highly controversial. Most important indication for intervention is symptomatology. It is still not agreed on, as of when cases are considered symptomatic. Therefore it is recommended to perform detailed neurologic, neuropsychologic, ophthalmologic and endocrinologic assessment in addition to radiologic evaluation in children with seemingly asymptomatic cysts under the age of four years or in older ones with large cysts of a Galassi score 3. In these cases regular follow up is recommended.

Acknowledgments I would like to thank Professor S. Puget, Professor N. Boddaert and Ms. Marie Laure Cuny at the Hôpital Necker in Paris for giving me the opportunity to participate in the research project investigating the neuropsychological and radiological outcome of children with temporo-sylvian arachnoid cysts.

I am very grateful to Professor Guzman for his help and advice and would like to thank the group of MedAlumni UZH for their support.