A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults

BACKGROUND: Intracranial arachnoid cysts are generally benign and can be asymptomatic or symptomatic. When symptoms are indicated, the effects of arachnoid cysts can be disabling to the patient. Quantitative assessment on the effectiveness of surgical intervention to relieve symptoms is inconsistently reported throughout the literature and is often contradictory. Due to this lack of direct evidence and disagreement among practitioners, nonsurgical treatment, such as pain management, is often prescribed. The objectives of this research were to evaluate the effectiveness of the 3 most common surgical treatments (craniotomy, endoscopic fenestration, and shunting) in relieving patient symptoms and to provide a resource of case study information for doctors and patients considering surgical intervention. METHODS: A worldwide literature review was performed using the PubMed database to collect reported data on case studies describing surgical intervention for intracranial arachnoid cysts. A meta-analytic review was performed on the viable data to investigate the overall surgical effectiveness for an adult population (aged 18 years or older). To increase the number of patient outcomes, some mixed data (case studies containing both adult and pediatric patients) were included in this study. RESULTS: The meta-analytic results show that, for the mixed adult and pediatric population, surgical treatment improves patient outcomes ((r) over bar = 0.828; P < 0.01), and the specific effects for craniotomy, shunting, and endoscopy are <(r)over bar> = 0.890, 0.738, and 0.892. For the adult-only population, the meta-analytic results show that surgical treatment also improves patient outcomes ((r) over bar = 0.667; P < 0.01), and the specific effects for craniotomy, shunting, and endoscopy are <(r)over bar> = 0.638, 0.684, and 0.727. CONCLUSIONS: The results indicate that surgical intervention is an effective approach to reduce or eliminate symptoms caused by intracranial arachnoid cysts.