Endoscopic treatment methods of suprasellar arachnoid cysts in children: A systematic review and meta-analysis

Endoscopic procedures, especially ventriculocystostomy (VC) and ventriculocystocisternostomy (VCC), are preferred treatments for suprasellar arachnoid cysts (SACs). Yet, results from current studies on their effects are varied. This study offers a comprehensive systematic review on surgical and clinical outcomes after VC and VCC and the risk of reoperation is compared by a meta-analysis. We conducted a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify surgical articles evaluating endoscopic treatment modalities for SAC using PubMed/Medline and Embase. The primary outcome was the risk of reoperation with a subgroup analysis among infants < 1 years of age. Postoperative complications were described to the extend they were reported in the literature. The risk of bias was assessed using the Newcastle-Ottawa scoring system. The meta-analysis was performed using RevMan 5.0 to compare the reoperation rates for VC and VCC as a risk ratio from a Forest plot with 95% confidence intervals in a fixed-effects model. Publication bias was assessed visually using a funnel plot. Nineteen observational studies were eligible for inclusion, comprising 94 patients who underwent VCC and 427 patients who underwent VC. Patients who underwent VCC had a significantly lower risk of reoperation of 0.33 (95% CI 0.17-0.65; p < 0.002). However, the risk of postoperative complications was considerable for both VCC (16.7%) and VC (12.7%), yet not significantly different (p = 0.915). Within the subgroup of infants age < 1 year, the risk of reoperation was significantly higher (29.4%) compared to older children (5.7%) (95% CI 1.96-42.07; p < 0.002). The results support VCC as an effective and long-lasting treatment for symptomatic SACs with significantly lower reoperation rates, compared to VC.