The Role of Age in Patient Presentation, Management, and Surgical Outcomes of Pediatric Middle Fossa Arachnoid Cysts: A Systematic Review and Meta-Analysis

Introduction: Arachnoid cysts are found in approximately 2.6% of the pediatric population with the middle fossa (MFAC) accounting for 46.9%. Because of the variability in size, presentation, and progression among children, we aimed to investigate the interplay between age, clinical presentation, management, and long-term outcomes.

Methods: A systematic review using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify articles detailing pediatric MFACs. Patients were divided into three NIH-defined age groups: infants ( < 2 years), children (2-11 years), and adolescents (12-18 years).

Results: 40 case reports including 150 pediatric MFAC patients with 114 males averaging 7.56±5.06 years old were included. 34 infants, 84 children and 32 adolescents were analyzed. Children, on average, were less likely to have complications due to MFAC management (OR:0.25, 95% CI:0.09-0.70, p=0.0083) compared to infants. Adolescents (12-18 years) also have lower average complication counts (OR:0.23, 95% CI:0.06-0.90, p=0.0351) than infants, but no significant difference was observed between children and adolescents (OR:0.90, 95% CI:0.21-3.85, p=0.8870). With age as a continuous variable, data showed a negative association between age and bilateral MFACs presentation (OR:0.71, 95% CI:0.52-0.98, p=0.0344). Additionally, older patients were less likely to require a second operation (OR:0.82, 95% CI:0.72-0.93, p=0.0023) and cerebrospinal fluid shunting (OR:0.88, 95% CI:0.79-0.97, p=0.0111).

Conclusion : These findings demonstrate the importance of greater surveillance in infants with MFACs during and after management of the cysts to minimize complications and prevent MFAC recurrence.