The efficacy of cysto-peritoneal shunting for the surgical management of intracranial arachnoid cysts in the elderly: a systematic review of the literature

Merola, Joseph, Manivannan, Susruta, Ooi, Setthasorn, Chia, Wen Li, Makwana, Milan, Lang, Jozef, Leach, Paul and Zaben, Malik J. ORCID: https://orcid.org/0000-0002-7446-4532 2021. The efficacy of cysto-peritoneal shunting for the surgical management of intracranial arachnoid cysts in the elderly: a systematic review of the literature. Surgical Neurology International 12 , 624. 10.25259/SNI_463_2021

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Abstract

Background: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort. Methods: Retrospective neurosurgical database search between January 2005 and December 2018, and systematic review of the literature using PRISMA guidelines were performed. Inclusion criteria: Age 60 years or older, radiological diagnosis of intracranial AC, neurosurgical intervention, and neuroradiological (NOG score)/clinical outcome (COG score). Data from both sources were pooled and statistically analyzed. Results: Our literature search yielded 12 studies (34 patients), which were pooled with our institutional data (13 patients). CP shunts (7 patients; 15%), cyst fenestration (28 patients; 60%) and cyst marsupialisation/resection (10 patients; 21%) were the commonest approaches. Average duration of follow-up was 23.6, 26.9, and 9.5 months for each approach, respectively. There was no statistically significant association between choice of surgical intervention and NOG score (P = 0.417), COG score (P = 0.601), or complication rate (P = 0.955). However, CP shunting had the lowest complication rate, with only one patient developing chronic subdural haematoma. Conclusion: CP shunting is a safe and effective surgical treatment strategy for ACs in the elderly. It has similar clinical and radiological outcomes but superior risk profile when compared with other approaches. We advocate CP shunting as first line neurosurgical intervention for the management of intracranial ACs in the elderly.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Additional Information:	This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License
Publisher:	Scientific Scholar
ISSN:	2229-5097
Date of First Compliant Deposit:	12 November 2021
Date of Acceptance:	2 November 2021
Last Modified:	04 May 2023 10:22
URI:	https://orca.cardiff.ac.uk/id/eprint/145478

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