2025 Poster Presentations
P378: BONE CEMENT VS BONE FLAP REPLACEMENT: A COMPARATIVE META-ANALYSIS OF POSTERIOR FOSSA CRANIOTOMY COMPLICATIONS
Ryan Neill, MS1; Peter Harris, MD2; Lekhaj Daggubati, MD2; 1The George Washington University School of Medicine and Health Sciences; 2The George Washington University Hospital Department of Neurosurgery
Objective: Posterior fossa surgeries are often performed to treat infratentorial pathologies such as tumors that increase intracranial pressure. Posterior fossa craniotomy has been shown to decrease incidence of postoperative complications and morbidity compared to craniectomy. More recently, the use of bone cement in posterior fossa craniotomies has been implemented, but there is limited comparative postoperative data of this technique to more commonly used bone flap replacement. This study aims to address this information gap through a meta-analysis comparing the incidence of postoperative cerebrospinal fluid leakage and other complications when utilizing bone cement versus bone flap replacement in posterior fossa craniotomies.
Methods: Following a literature review, search parameters for a systematic review were identified and relevant studies were sorted based on selection criteria to be included in the meta-analysis under PRISMA guidelines. Data analysis was performed in R studio and Microsoft Excel software. Targeted complications for analysis include: CSF leakage, pseudomeningocele formation, and infection. Pooled estimates and odds ratios for dichotomous outcomes were calculated with corresponding 95% confidence intervals and findings were translated into illustrative tables and figures.
Results: Twenty-one articles were included from systematic review, nine studies using bone cement and thirteen using bone flap (two studies reported data for both groups). With bone flap replacement, CSF leakage was 8.36% (95% CI 5.89% to 10.86%), pseudomeningocele formation was 9.22% (95% CI 4.82% to 13.62%), and infection was 6.85% (95% CI 4.05% to 9.65%). With bone cement usage, CSF leakage was 3.47% (95% CI 2.37% to 4.57%), pseudomeningocele formation was 2.43% (95% CI 1.23% to 3.63%), and infection was 1.85% (95% CI 0.75% to 2.95%). The odds ratio of CSF leak, pseudomeningocele formation, and infection was 0.39 (95% CI 0.229 to 0.559), 0.25 (95% CI 0.137 to 0.353), and 0.26 (95% CI 0.149 to 0.363) respectively with the use of bone cement compared to craniotomy.
Conclusions: Outcomes demonstrated in this meta-analysis revealed an overall decreased incidence of postoperative complications rates of CSF leak, pseudomeningocele formation, and infection when using bone cement compared to bone flap in posterior fossa craniotomies. Our study suggests bone cement use is safe and effective in posterior fossa surgery. Future studies should further assess comparative outcomes of these techniques.