Magnesium Sulfate as a Multimodal Anesthetic Adjuvant in Brain Tumor Surgery: A Systematic Review and Meta-Analysis...

Background/Objectives: Strict hemodynamic stability is critical during supratentorial craniotomy. This systematic review and meta-analysis aimed to evaluate the efficacy of magnesium sulfate (MgSO₄) as a multimodal adjuvant on intraoperative hemodynamics, opioid consumption, and biomarker outcomes in this setting. Methods: We systematically searched PubMed, Scopus, EBSCO, and the Cochrane Library for randomized controlled trials (RCTs) comparing perioperative MgSO₄ administration to placebo or standard care in adult patients undergoing elective supratentorial craniotomy. Results: Meta-analysis of nine included RCTs using a random-effects model demonstrated that MgSO₄ significantly reduced intraoperative mean arterial pressure (mean difference [MD]: -4.65 mmHg; 95% confidence interval [CI]: -7.76 to -1.55; p = 0.0033; I² = 73.6%). Furthermore, MgSO₄ administration significantly lowered postoperative serum S100B levels (standardized MD [SMD]: -0.81; 95% CI: -1.24 to -0.38; p = 0.0002, I² = 0.0%), indicating mitigated cellular neural damage, and decreased perioperative fentanyl consumption (standardized MD: -1.01; 95% CI: -1.45 to -0.57; p < 0.0001; I² = 0.0%). Intraoperative blood loss volume did not differ significantly between groups (MD: -85.03 mL; 95% CI: -331.42 to 161.37; p = 0.4952; I² = 92.5%). Conclusions: MgSO₄ is a safe and effective multimodal adjuvant for supratentorial craniotomy, providing significant hemodynamic stability, opioid-sparing effects, and preliminary biochemical evidence suggestive of neuroprotection without compromising intraoperative hemostasis.