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

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• 作者：Yong Chen¹ ; ² ; Hong-Juan Fang³ ; Zhi-Feng Li¹ ; Sheng-Yuan Yu² ; Chu-Zhong Li² ; Zhe-Bao Wu⁴ ; Ya-Zhuo Zhang² ; ^{zyz2004520@yeah.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cystoperitoneal shunting ; Meta-analysis ; Microsurgical fenestration ; Middle cranial fossa arachnoid cysts ; Neuroendoscopic fenestration
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：92
• 期：Complete
• 页码：480-490.e2
• 全文大小：7386 K

文摘

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.