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Minimally Invasive Versus Traditional Repair of Spinal Cerebral Spinal Fluid Leaks: A Systematic Review and
W Elorm Yevudza1, Gayle Salama2, John K Park3
1Department of Neurosurgery, NewYork-Presbyterian Queens, Flushing, New York, USA.
World Neurosurgery
|April 1, 2026
Summary
Minimally invasive surgery (MIS) for spontaneous spinal cerebrospinal fluid (CSF) leaks shows high primary closure success (95%) and low recurrence (10%). While MIS and open repairs appear similar, more research is needed to confirm effectiveness due to data limitations.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Spinal Surgery
Background:
- Spontaneous spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension.
- Minimally invasive surgical (MIS) approaches aim to decrease patient recovery time and surgical complications.
- The comparative effectiveness of MIS versus open surgical repair for these leaks is not well-defined.
Purpose of the Study:
- To systematically review and meta-analyze surgical series on spontaneous spinal CSF leaks.
- To compare the effectiveness of minimally invasive surgery (MIS) versus open repair.
- To assess primary closure success, recurrence rates, and symptom resolution.
Main Methods:
- Systematic review and meta-analysis following PRISMA 2020 guidelines.
- Included contemporary surgical series of spontaneous spinal CSF leak repairs.
- Quantitative synthesis of nine studies and qualitative synthesis of twenty studies.
Main Results:
- Overall primary closure success was 95% and recurrence/reoperation occurred in 10% of cases.
- Subgroup analysis showed numerically similar closure (97% vs. 92%) and recurrence (10% vs. 9%) rates between MIS and open repairs.
- Complete symptom resolution was 71% in open repair cohorts; MIS data for symptom resolution was not quantitatively pooled.
Conclusions:
- Minimally invasive surgery (MIS) dural repair may achieve success rates comparable to open procedures with similar complication profiles in select cases.
- The observational nature of current data and potential selection bias preclude definitive comparative conclusions.
- Prospective studies are required to control for selection bias and definitively compare MIS and open surgical repair outcomes for spinal CSF leaks.
