Treatment of Middle Cranial Fossa Arachnoid Cysts: A Systematic Review and Meta-Analysis.

Abstract

To review the literature and analyze the efficacy and safety of 3 surgical methods (neuroendoscopic fenestration, microsurgical fenestration, and cystoperitoneal shunting) for middle cranial fossa arachnoid cysts (MCFACs). We searched MEDLINE, PubMed, and Cochrane Central electronic databases and collected studies of patients with MCFACs treated with 1 of 3 surgical methods. Eligible studies reported the rate of clinical symptoms improvement (RCSI), rate of cyst reduction (RCR), rate of total complications (RTC), rate of short-term complications (RSTC), rate of long-term complications (RLTC), and other parameters. Eighteen studies met the criteria. MCFACs were divided into 3 groups on the basis of surgical method: RCSI in group I (237 patients, neuroendoscopic fenestration) was 90% (95% confidence interval [CI]: 83%-95%); RCR: 76% (95% CI: 67%-84%); RTC: 28% (95% CI: 22%-34%); RSTC: 23% (95% CI: 17%-30%); and RLTC: 6% (95% CI: 3%-11%). RCSI in group II (144 patients, microsurgical fenestration) was 87% (95% CI: 75%-96%); RCR: 87% (95% CI: 70%-97%); RTC: 49% (95% CI: 30%-68%); RSTC: 44% (95% CI: 21%-68%); RLTC: 3% (95% CI: 0%-12%). RCSI in group III (93 patients, cystoperitoneal shunting) was 93% (95% CI: 66%-99%); RCR: 93% (95% CI: 66%-99%); RTC: 20% (95% CI: 5%-42%); RSTC: 10% (95% CI: 0%-31%); RLTC: 15% (95% CI: 9%-23%). RLTC differed significantly between the 3 groups (P = 0.005); RTC and RSTC between group I and group II (P = 0.002). All 3 surgical methods are effective for MCFACs, but considering safety, neuroendoscopic fenestration may be the best initial procedure.