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

ABSTRACT

OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: All 3 surgical methods are effective for MCFACs, but considering safety, neuroendoscopic fenestration may be the best initial procedure.