Different surgical options for the management of symptomatic intracranial arachnoid cysts: A systematic review

Abstract

Background: Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid CSF-filled spaces lined with arachnoid membranes. Small arachnoid cysts are mostly asymptomatic and may warrant watchful waiting and serial imaging follow-up. However, large arachnoid cysts are often symptomatic because they compress surrounding structures causing increased intracranial tension, fits, behavioral changes or visual hallucinations according to its site/size, therefore, they must be treated surgically. As several surgical management options exist, the best approach should be chosen according to each type of arachnoid cyst. Ongoing research aims to enhance our understanding of the clinical characteristics of these lesions, refine diagnostic approaches, and optimize treatment strategies to improve outcomes and quality of life for affected individuals.Objective: The objective of this study is to compare between different surgical approaches in treatment of symptomatic intracranial arachnoid cysts mainly microscopic fenestration, endoscopic fenestration & cystoperitoneal shunt in terms of short and long-term effectiveness and complications in different types of arachnoid cysts.Data Sources: Medline databases (PubMed, Medscape, EMBASE, ScienceDirect, Cochrane database of systematic reviews) and all materials available in the Internet till 2024.Data Extraction: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.Conclusion: Ourdata showed that all three surgical methods are effective treatments in terms of clinical improvement with no statistically significant difference among them, however, microsurgical fenestration is favored over CP shunt with statistically significant difference. Microsurgical fenestration was followed by the highest incidence of postoperative cyst volume reduction (86.2%) with statistically significant difference. On the other hand, endoscopic fenestration was accompanied by the lowest rate of recurrence (19%) with statistically significant difference. The three modalities showed statistically non-significant difference in terms of post-operative short-term complications and permanent neurological deficits.Further prospective randomized controlled trials are recommended to evaluate the surgical options, using clear and explicit criteria for inclusion, objective outcome definitions and assessment, and ensuring a consistent long follow-up to minimize the uncertainty in some data such as long-term complications and incidence of permanent deficits.