Treatment of Middle Cranial Fossa Arachnoid Cysts: A Systematic Review and Meta-Analysis.
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.
Department of Neurosurgery, Yueyang Second People's Hospital, Yueyang, China; Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing Institute for Brain Disorders Brain Tumor Center, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
Yong
Y
Chen
Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Hong-Juan
HJ
Fang
Department of Neurosurgery, Yueyang Second People's Hospital, Yueyang, China.
Zhi-Feng
ZF
Li
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing Institute for Brain Disorders Brain Tumor Center, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
Sheng-Yuan
SY
Yu
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing Institute for Brain Disorders Brain Tumor Center, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
Chu-Zhong
CZ
Li
Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Zhe-Bao
ZB
Wu
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing Institute for Brain Disorders Brain Tumor Center, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China. Electronic address: zyz2004520@yeah.net.
Ya-Zhuo
YZ
Zhang
D000293:Adolescent; D016080:Arachnoid Cysts / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D035301:Cranial Fossa, Middle / Q000601:surgery; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D044583:Neuroendoscopy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*
Cystoperitoneal shunting; Meta-analysis; Microsurgical fenestration; Middle cranial fossa arachnoid cysts; Neuroendoscopic fenestration