Construction And Application Of Predictive Scoring Model For Surgical Intervention Treatment Of Pediatric Intracranial Arachnoid Cyst

Part Ⅰ Construction of a predictive scoring model for surgical intervention treatment of pediatric intracranial arachnoid cyst Background and purpose:Intracranial arachnoid cysts(IACs)are benign brain cyst lesions,which occur mostly due to congenital arachnoid division abnormalities,cerebrospinal fluid accumulates in the cyst,and the cyst wall is arachnoid,pia mater,glial cells,etc.The enlargement of the cyst will produce a mass effect,and surgery needs to be considered when causing damage to the child’s brain development,but because it is difficult to clarify the direct relationship between the patient’s symptoms and the cyst,the indications for surgery are not yet uniform.This study aims to retrospectively analyze the clinical data of children with IACs admitted to Zhujiang Hospital of Southern Medical University from January 2015 to December 2021,and establish an effective scoring model to predict whether children with IACs need early surgical intervention.Methods:The clinical data of 117 children with IACs in a single center were retrospectively analyzed,and the cyst volume reduced by more than 20%during postoperative follow-up and the children with improved symptoms were classified as the recommended surgical treatment group.Children with unoperated arachnoid cysts with worsening symptoms or enlarged cysts during dynamic observation were grouped into the recommended surgical treatment group;Patients without surgery,who were asymptomatic during ambulatory observation or whose cyst was not enlarged,were classified as recommended conservative management.Using SPSS version 25 statistical software,the univariate analysis was used to analyze whether there were statistical differences between the recommended surgical treatment group and the recommended conservative treatment group,and the differential factors were included in the binary logistic regression analysis,and a scoring system was constructed according to the regression analysis results.Results:A total of 117 children met the inclusion criteria,and of these 117,53 underwent surgery and had a good prognosis.Sixty-four patients did not undergo surgical treatment,of which 18 had worsening symptoms during follow-up and were recommended for surgical intervention,while 46 had no enlarged cysts during followup and had no symptoms of exacerbation,and conservative treatment was recommended.Significant compression of brain tissue(P=0.003,OR=5.6),ventricular compression(P=0.017,OR=8.4),and cyst volume(P=0.001,OR=2.6)were independent predictors of the need for surgery.According to the scoring model we established,it was found that the higher the score,the more surgery was required,among which 14.63%of children with scores less than or equal to 3 required surgery,and 85.52%of children with scores greater than 3 required surgery.Conclusions:According to the clinical data,the meaningful impact factor was incorporated into the scoring model by using univariate and multivariate regression analysis methods,and the effectiveness of the scoring method could be detected after application in 117 patients,and this new scoring model was of significance for predicting whether pediatric arachnoid cyst patients needed surgical treatment,and patients with scores less than or equal to 3 were recommended for conservative treatment and regular follow-up observation.Patients with a score greater than 3 are advised to undergo early surgery.However,no statistically significant differences in age and cyst growth location between the recommended surgical group and the recommended conservative treatment group were found in this study,and further prospective cohort studies are needed to obtain a more comprehensive,adequate and effective scoring prediction model.Part II:Application of scoring model and efficacy analysis of surgical intervention treatment of pediatric arachnoid cystBackground and purpose:Arachnoid cyst is a common intracranial congenital cystic lesion in children,and its indications for surgery have been controversial,and a more unified consensus is that patients who can clarify the causal relationship between symptoms and arachnoid cyst,patients younger than 4 years old,patients with cyst diameter greater than 4 cm,there is a significant mass effect,and patients with non-communicating arachnoid cyst often need surgery.This chapter studies a retrospective cohort study to validate the predictive scoring model proposed in the first chapter of this study.The efficacy of different surgical methods is further discussed to suggest the best surgical strategy.Method:A retrospective cohort analysis of 28 children with arachnoid cyst from January 2022 to March 2023 was excluded,4 of which were not significantly reduced after surgery,and for the remaining 24 children who met the inclusion criteria of the study,according to the scoring model proposed in Chapter 1,they were divided into groups with scores less than or equal to 3 and groups with scores greater than 3,and their symptom improvement and cyst volume reduction were followed up,and SPSS 25.0 was used The statistical analysis software analyzed whether the difference in scores between the two groups whether surgery was recommended was statistically significant to verify the effectiveness of the model construction in Chapter 1.A retrospective analysis was performed for 58 children with arachnoid cyst who underwent surgery from January 2015 to December 2021,and followed up the reduction of postoperative cyst volume,the incidence of short-term postoperative complications and the long-term postoperative complications,in order to compare the efficacy differences of different surgical methods.Outcome:The percentage of recommended surgical treatment was 38.46%with a score of less than or equal to 3 groups,and 81.82%with a score greater than 3 groups.P=0.047<0.05.The results showed that the difference in the recommended surgical treatment between the two groups was statistically significant,which could support the establishment of the scoring model in Chapter 1 of this study.There was no significant difference in the effective rate of the three surgical methods(P=0.838>0.05),the short-term postoperative complication rate(P=0.850>0.05),and the long-term postoperative complication rate(P=0.228>0.05)between the groups,and there was no difference in the postoperative efficacy of the three surgical methods.Conclusion:This study follows the retrospective cohort study method,which confirms the preliminary validity of the predictive scoring model constructed in Chapter 1.The retrospective case analysis of 58 children with arachnoid cyst treated by surgery found no significant difference in surgical efficiency and postoperative complication rate between different surgical methods.Therefore,clinicians still need to comprehensively determine the appropriate surgical method according to the patient’s arachnoid cyst growth location and the patient’s own condition.