Meta Analysis Of The Effect Of Craniotomy And Endoscopic Fenestration On Arachnoid Cyst In Middle Cranial Fossa Of Children

Objective:To evaluate the clinical effect of microsurgicalfenestration and neuroendoscopic fenestration in children with middle cranial fossa arachnoid cyst via a meta-analysis,so as to provide a reference for the clinical treatment and further studies of acromegaly patients.Methods:Pub Med,EMBASE,Cochrane Library,and Web of Science were used to search for clinical studies of microsurgery fenestration and neuroendoscopic fenestration in the treatment of arachnoid cyst of middle cranial fossa in children published before December2019.After screening the literatures according to the inclusion criteria and exclusion criteria,Eligible studies reported the rates of: the rate of clinical symptoms improvement(RCSI),the rate of cyst reduction(RCR),the rate of short-term complication(RSTC),the rate of long-term complication(RLTC),and other parameters,For outcome measures,the final selection rate and its 95% confidence interval(CI)describe the results.R3.6.0 is used for statistical analysis.Using the meta-analysis of single rate,after the logarithmic conversion of the rate of each literature,the effect value was integrated.SPSS 25.0 was used to test the four indexes of endoscopy group and microscope group,and I2 and P were used to evaluate the heterogeneity of each literature.Results:Twelve articles involvingfourteen studies were eventually included,including 374 children with arachnoid cysts in the middle cranial fossa.According to the different operation methods,they were divided into microscope group and neuroendoscopy group.212 patients underwent craniotomy and fenestration,162 patients underwent neuroendoscopic fenestration.Meta analysis showed that the RCSI of 212 patients in the microscope group was 85%,95% CI(0.76,0.95);RCR: 86%,95% CI(0.78,0.94);RSTC:31%,95% CI:(0.17,0.56);RLTC: 7%,95% CI:(0.03,0.18).In 162 patients with neuroendoscopy,the RCSI was 95%,95% CI:(0.91,0.99);RCR: 80%,95% CI:(0.70,0.91);RSTC:29%,95% CI:(0.23,0.38);RLTC: 22%,95% CI:(0.16,0.30).Subgroup analysis showed that: four grid chi square test was carried out for the four clinical indexes of neuroendoscopic group and microscope group respectively.The results showed that the ratio of RCSI and RSTC in the two groups was almost the same,so there was no significant difference between the two groups.In RCR and rltc,the composition ratio of the two groups was different.The RCR of the neuroendoscopic group was lower than that of the microscopical group,and the RLTC of the neuroendoscopic group was higher than that of the microscopical group.Conclusion:For children with arachnoid cyst in the middle cranial fossa,both microsurgery and endoscopic fenestration are effective.In terms of clinical efficacy,the clinical symptoms of the two groups were significantly improved,the difference was not statistically significant;the reduction rate of cysts in the neuroendoscopic group was higher than that in the craniotomy microscope group.In terms of safety,the short-term complications of the two groups were similar,the difference was not statistically significant;the long-term complications of the neuroendoscopic group was higher than that of the craniotomy microscope group.Limited by the published literature,there is no evidence of randomized controlled study,so the clinical efficacy and safety of children's middle cranial fossa arachnoid cyst still need further study to confirm.