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Background and objective <p>Cerebrospinal fluid leaks or fistulas are a relatively common neurosurgical pathology. Classically, this condition has been managed through an open surgical approach, but endoscopic surgery has emerged as a less invasive alternative with several advantages. Despite this, no meta-analysis has yet directly compared the clinical outcomes of these two management strategies.</p> Methods <p>A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Embase, LILACS and Web of Science databases were rigoursly searched. Post-operative repair success rate, risk of recurrence and the risk of presenting any operation-related compilation and the all-cause mortality rate were analyzed. Data were analyzed using a common-effects meta-analysis, and statistical heterogeneity was assessed. The study was registered with PROSPERO (CRD42024606877).</p> Results <p>Seven studies comprising 360 patients (140 endoscopic, 220 open) were included. Although the point estimate suggested a higher success rate with endoscopic repair, the difference was not statistically significant OR 1.32 (95% CI 0.55–3.16, I2 = 4.4%). The complication rate was significantly lower in the endoscopic group OR 0.27 (95% CI 0.11–0.69, I2 = 32%) and a leave-one-out analysis excluding the study by Gassner et al. found OR 0.10 (95% CI 0.03–0.33, I2 = 0%). Recurrence of CSF fistulas showed a trend favoring endoscopic repair (OR 0.78, 95% CI 0.42–1.43, I2 = 0%). No mortality was reported.</p> Conclusions <p>Endoscopic CSF fistula repair demonstrates a superior safety profile and is non-inferior in terms of efficacy compared to open surgery. Given the limited number of high-quality studies, further research is needed and larger, well-designed studies are recommended to refine clinical decision-making and optimize patient care.</p>

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Efficacy and safety of endoscopic compared with open surgical repair of cerebrospinal fluid fistulas: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年7月15日

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  • Marco Frusteri,
  • Miguel Gaviria Zapata,
  • Juan Esteban Suárez Sepúlveda,
  • Carlos Rivas,
  • Esteban Quiceno,
  • Daniel Londoño Herrera,
  • Francisco Javier Londoño Ocampo

摘要

Background and objective

Cerebrospinal fluid leaks or fistulas are a relatively common neurosurgical pathology. Classically, this condition has been managed through an open surgical approach, but endoscopic surgery has emerged as a less invasive alternative with several advantages. Despite this, no meta-analysis has yet directly compared the clinical outcomes of these two management strategies.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Embase, LILACS and Web of Science databases were rigoursly searched. Post-operative repair success rate, risk of recurrence and the risk of presenting any operation-related compilation and the all-cause mortality rate were analyzed. Data were analyzed using a common-effects meta-analysis, and statistical heterogeneity was assessed. The study was registered with PROSPERO (CRD42024606877).

Results

Seven studies comprising 360 patients (140 endoscopic, 220 open) were included. Although the point estimate suggested a higher success rate with endoscopic repair, the difference was not statistically significant OR 1.32 (95% CI 0.55–3.16, I2 = 4.4%). The complication rate was significantly lower in the endoscopic group OR 0.27 (95% CI 0.11–0.69, I2 = 32%) and a leave-one-out analysis excluding the study by Gassner et al. found OR 0.10 (95% CI 0.03–0.33, I2 = 0%). Recurrence of CSF fistulas showed a trend favoring endoscopic repair (OR 0.78, 95% CI 0.42–1.43, I2 = 0%). No mortality was reported.

Conclusions

Endoscopic CSF fistula repair demonstrates a superior safety profile and is non-inferior in terms of efficacy compared to open surgery. Given the limited number of high-quality studies, further research is needed and larger, well-designed studies are recommended to refine clinical decision-making and optimize patient care.