Impact of cement cranioplasty on cerebrospinal fluid leaks after retrosigmoid craniotomy − A systematic review and meta-analysis

Background: Cerebrospinal fluid (CSF) leaks and related complications (CLRC) are common after retrosigmoid approaches for cerebellopontine angle (CPA) surgeries. Bone cement cranioplasty (CCP) may provide additional sealing benefits over reconstruction without cement (RWC) in reducing these complications. This study aimed to compare the outcomes of CCP versus RWC in CPA surgery. Methods: A systematic review and meta-analysis following PRISMA guidelines was conducted using three databases (PubMed, Scopus, Web of Science). Studies were included comparing CCP and RWC in retrosigmoid craniotomies/craniectomies for CPA pathologies. Primary outcomes were pseudo meningocele, external CSF leaks, and CLRC, while secondary outcomes included wound infection rates and rates of reoperation for wound problems. Results: Five retrospective studies were analyzed with 1,838 patients (931 CCP, 907 RWC). CCP significantly reduced the rates of pseudo meningocele (OR 0.264, CI 0.150–0.463), wound CSF leaks (OR 0.105, CI 0.028–0.399) and CLRC (OR 0.248, CI 0.078–0.794). In the CCP group, there were fewer wound infections (OR 0.310, CI 0.114–0.790) and lower reoperation rates (OR 0.189, CI 0.050–0.708). Conclusions: Cement cranioplasty is associated with a lower incidence of CSF leaks and related complications compared to RWC following retrosigmoid approaches for CPA pathology. CCP also reduces reoperations and wound infections. These findings support using CCP as an effective technique for lowering postoperative complications of retrosigmoid approaches.