Evidence map›Paper›PMID 41407970›Full record

SynthesisNeurosurgical review2025

Craniotomy versus craniectomy in posterior fossa tumor surgery: A systematic review and Meta-Analysis.

Eduardo Mendes Correa, Pedro Henrique Costa Ferreira-Pinto, Leticia Riccio Walsh Brando, Vinicius Pereira, Alexandre Carrion, Domênica Baroni Coelho de Oliveira Ferreira, George Divério, Othavio Lopes, Flavio Nigri

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Eduardo Mendes CorreaNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil. Drcorreaneuro@gmail.com.ORCID http://orcid.org/0000-0002-6863-8997
Pedro Henrique Costa Ferreira-PintoNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
Leticia Riccio Walsh BrandoNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
Vinicius PereiraNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
Alexandre CarrionNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
Domênica Baroni Coelho de Oliveira FerreiraNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
George DivérioNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
Othavio LopesNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.
Flavio NigriNeurosurgery, Department of Surgical Specialities, Pedro Ernesto University Hospital, State University of Rio De Janeiro, Rio de Janeiro, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Surgery for posterior fossa tumors carries a high risk of cerebrospinal fluid (CSF)-related complications, including leaks and pseudomeningocele, which increase morbidity, prolonged hospital stay, and contribute to healthcare costs. While advances in dural closure techniques and sealants have aimed to reduce these complications, the choice between craniotomy (bone flap replacement) and craniectomy (bone removal without replacement) remains variable and lacks consensus. This systematic review and meta-analysis aimed to compare postoperative outcomes between these two surgical techniques in the specific context of posterior fossa tumor resection. A systematic search of PubMed, Embase, and Web of Science through March 2025 identified eligible studies. The protocol was registered in PROSPERO (CRD420251038861). Studies comparing craniotomy and craniectomy in posterior fossa tumor surgery and reporting outcomes of interest (CSF leak, pseudomeningocele, hydrocephalus, wound or CNS infection, length of stay) were included. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated using the GRADE framework. Meta-analyses were performed using random-effects models. Four studies comprising 385 patients were included. Craniotomy significantly reduced the risk of CSF leak (OR: 0.19; 95% CI: 0.07–0.48) and pseudomeningocele (OR: 0.27; 95% CI: 0.13–0.57), and decreased hospital stay by an average of 3.4 days (MD: − 3.35; 95% CI: − 5.71 to − 0.99) compared to craniectomy. These findings correspond to an absolute risk reduction of approximately 11% for CSF leak and pseudomeningocele, with a number needed to treat of 9 to prevent one additional complication. No significant differences were observed for postoperative hydrocephalus, wound infection, or CNS infection. The certainty of evidence was rated as moderate for CSF-related outcomes and length of stay, and low for infection-related outcomes and hydrocephalus. Craniotomy may be associated with reduced CSF-related complications and shorter hospital stay compared with craniectomy in posterior fossa tumor surgery. These findings support the potential role of bone flap replacement in reducing morbidity and healthcare burden; however, the evidence remains limited by the small number and observational design of available studies, warranting cautious interpretation. Well-designed prospective trials are warranted to validate these associations and guide standardized reconstruction strategies in this high-risk population.

Indexed as

CraniotomyInfratentorial NeoplasmsCerebrospinal Fluid LeakHumansLength of StayNeurosurgical ProceduresPostoperative ComplicationsCerebrospinal fluid leakCraniectomyCraniotomyLength of hospital stayPosterior fossa tumorPseudomeningocele

Identifiers

PMID41407970

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.