Acta Neurochirurgica (2025) 167:264
This systematic review and meta-analysis identified higher postoperative CSF fistula risk after infratentorial and tumor surgeries, and with primary closure. Patch grafts and watertight techniques reduce leak rates. CSF leaks are strongly linked to postoperative infections, highlighting the importance of preventive strategies in cranial neurosurgery.
Postoperative cerebrospinal fluid (CSF) fistulas are a common complication after craniotomy and craniectomy, with incidence rates ranging from 1% to 10%.
• Infratentorial surgeries have a higher CSF leak rate (7.9%) than supratentorial ones (4.6%).
• Tumor surgeries show greater risk of CSF leak than vascular procedures (odds ratio 1.82).
• Primary dural closure has a higher leak rate (12.3%) compared to patch grafts (8.5%).
• Watertight dural closure trends toward fewer leaks, but current evidence is not statistically significant.
• CSF leaks are strongly associated with postoperative infections (34.1%).
• Prevention of CSF leaks is crucial to reduce infection risk and improve surgical outcomes.
• Limitations include heterogeneous study definitions, inconsistent reporting of comorbidities, and lack of standardized data on closure techniques.
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