Craniotomia versus craniectomia em cirurgias de tumores da fossa posterior: revisão sistemática e metanálise

Abstract

Surgery for posterior fossa tumors carries a high risk of cerebrospinal fluid (CSF)-related complications, particularly CSF leak and pseudomeningocele, which increase morbidity, prolong hospital length of stay, and raise healthcare costs. Despite advances in dural closure techniques, uncertainty remains regarding the comparative effectiveness of craniotomy with bone flap replacement versus craniectomy without replacement. This study compared postoperative outcomes between these techniques, focusing on CSF-related complications, infection, and hospital length of stay. A systematic review and meta-analysis were conducted according to PRISMA guidelines, with the protocol registered in PROSPERO (CRD420251038861). PubMed, Embase, and Web of Science were searched through March 2025. Comparative studies reporting CSF leak, pseudomeningocele, hydrocephalus, wound or central nervous system infection, or hospital length of stay were included. Risk of bias was assessed using the Newcastle–Ottawa Scale and certainty of evidence using the GRADE framework. Four studies comprising 385 patients met the inclusion criteria. Craniotomy significantly reduced the risk of CSF leak (odds ratio [OR] = 0.19; 95% confidence interval [CI]: 0.07–0.48) and pseudomeningocele (OR = 0.27; 95% CI: 0.13–0.57), corresponding to an absolute risk reduction of 11% and a number needed to treat of 9. Hospital length of stay was reduced by a mean of 3.35 days in the craniotomy group (95% CI: –5.71 to –0.99). No significant differences were observed for hydrocephalus or infection outcomes. Certainty of evidence was moderate for CSF-related outcomes and hospital length of stay and low for infection-related outcomes. In conclusion, craniotomy is associated with fewer CSF-related complications and shorter hospital length of stay than craniectomy in posterior fossa tumor surgery, although the available evidence is limited by the observational nature of the included studies.