The role of age and Galassi type in management and surgical outcomes of pediatric middle fossa arachnoid cysts: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: p = 0.002 for repeat operations, p = 0.011 for CSF shunting

• Effect Size: Younger patients: OR 0.82 for repeat operations, OR 0.88 for CSF shunting

• Primary Outcome: Age-related differences in MFAC presentation and surgical outcomes

• Nnt Or Sensitivity: 22.2% prevalence of elevated ICP signs, 30.1% prevalence of primary headaches

• Confidence Interval: Repeat operations: 95% CI 0.72-0.93; CSF shunting: 95% CI 0.79-0.97

Clinical Application

Applicable to Australian pediatric neurosurgery centers with appropriate imaging and surgical capabilities Relevant to Australian pediatric neurosurgeons and neurologists; findings support enhanced surveillance protocols for younger patients under current Australian healthcare guidelines Australian pediatric patients with middle fossa arachnoid cysts, particularly those under 5 years

Abstract

PURPOSE: Arachnoid cysts are found in approximately 2.6% of the pediatric population, mostly asymptomatic, incidental findings. However, those with mass effect symptoms from cyst growth may require surgery. Because of the variability in progression, we investigated the interaction of patient age with middle fossa arachnoid cyst (MFAC) clinical outcomes. METHODS: A systematic review using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles detailing pediatric MFACs. RESULTS: Sixty articles meeting the inclusion criteria, totaling 1024 patients, were included. Signs of elevated ICP (194/873, prevalence: 22.2%, 95% CI: 19.5-25.0%) and primary headaches (263/873, prevalence: 30.1%, 95% CI: 27.1-33.2%) were the most common presenting symptoms. In the evaluation of the hemispheric location of MFACs, younger ages at presentation were more likely to present with bilateral MFACs (OR: 0.71, 95% CI: 0.52-0.98, p = 0.034). Most MFACs in the retrospective studies had left laterality (421/677, prevalence: 62.2%, 95% CI: 58.6-65.1%) and were singular (791/817, prevalence:96.8%, 95% CI: 95.6-98.2%). A higher proportion of younger patients required a second operation (OR: 0.82, 95% CI: 0.72-0.93, p = 0.002) and cerebrospinal fluid shunting (OR: 0.88, 95% CI: 0.79-0.97, p = 0.011) across the case reports. There was no significant difference in complications when comparing older children (5-18 years) to young children (≤ 4 years) (p = 0.737) or Galassi type (p = 0.736), but Galassi type 1 was associated with management through observation (p = 0.019). CONCLUSION: Younger patients presented with a higher rate of bilateral MFACs and required more invasive treatment methods and repeat operations more frequently, suggesting that infants and young children with MFACs may require greater surveillance during and after management to minimize complications.

References

1. 1.Jenkins, A., Guirguis, M., Smith, P., Witten, G., Anand, S., Wang, J., Farid, M., O'Leary, S., Barrie, U., & Braga, B. P. (2026). The role of age and Galassi type in management and surgical outcomes of pediatric middle fossa arachnoid cysts: a systematic review and meta-analysis. Child's Nervous System. https://doi.org/10.1016/B978-0-444-64150-2.00011-3