Cerebrospinal fluid leakage after cranial surgery in the pediatric population-a systematic review and meta-analysis

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Clinical Epidemiology

Background:

• Cerebrospinal fluid (CSF) leakage is a frequent complication post-neurosurgery, leading to significant patient morbidity and increased healthcare expenses.
• Quantifying the incidence and identifying risk factors for CSF leakage in pediatric neurosurgery is crucial for improving patient outcomes.

Purpose of the Study:

• To systematically review and meta-analyze the incidence of cerebrospinal fluid leakage in pediatric patients undergoing intradural cranial surgery.
• To identify specific risk factors associated with cerebrospinal fluid leakage in this population.

Main Methods:

• Adherence to PRISMA guidelines for systematic review and meta-analysis.
• Comprehensive literature search of Embase, PubMed, and Cochrane databases for relevant studies.
• Meta-analysis of incidences using a generalized linear mixed model for pediatric patients (<18 years) undergoing intradural cranial surgery.

Main Results:

• Twenty-six articles comprising 2929 patients and 3034 surgeries were included; only four studies defined CSF leakage.
• The overall incidence of CSF leakage was 4.4% (95% CI 2.6 to 7.3%).
• Craniectomy (OR 4.7) and infratentorial surgery (OR 5.9) significantly increased CSF leakage odds, whereas duraplasty use (OR 0.41) significantly decreased them.

Conclusions:

• The incidence of CSF leakage after pediatric intradural cranial surgery is 4.4%, with craniectomy and infratentorial approaches being identified risk factors.
• Duraplasty use demonstrates a protective effect against CSF leakage.
• A standardized, unambiguous definition of CSF leakage, such as 'leakage of CSF through the skin,' is recommended to enhance future research consistency and comparability.