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The extracranial versus intracranial approach In frontoethmoidal encephalocele corrective surgery: a meta-analysis

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Abstract

The debate between the extracranial and the intracranial approach for frontoethmoidal (FEE) encephalocele corrective surgery was not summarized yet. The extracranial approach is traditionally believed being inferior to the intracranial approach, but convincing evidence was missing. To provide robust evidence, we conducted a meta-analysis on the incidence of cerebrospinal fluid (CSF) leakage, its progression to infection, the reoperation to treat the leakage, and the recurrence rate between the two techniques. We performed a meta-proportion pooled analysis and meta-analysis on eligible literature following the recommendation of PRISMA guidelines. The outcome of interest was the incidence of CSF leakage, the CSF leakage that progressed into an infection, the reoperation rate to treat the leakage, and the recurrence rate. We included 28 studies comprising 1793 patients in the pooled prevalence calculations. Of the 28 studies, nine studies describing 730 patients were eligible for meta-analysis. The prevalence of CSF leakage was 8% (95% CI, 0.04–0.12) in the intracranial approach and 10% (95% CI, 0.01–0.23) in the extracranial approach The subgroup analysis of the intracranial approach showed higher CSF leakage prevalence in the frontal craniotomy approach (9%; 95% CI, 0.03–0.16) than the subfrontal osteotomy (6%; 95% CI, 0.03–0.12). Meta-analysis study revealed a significantly higher risk of CSF leakage (OR 2.82; 95% CI, 1.03–7.72), a higher reoperation rate (OR 5.38; 95% CI: 1.13 – 25.76), and the recurrence rate (RR 4.63; 95% CI, 1.51–14.20) for the extracranial approach. The event of infected CSF leakage (OR 3.69; 95% CI, 0.52–26.37) was higher in the extracranial than intracranial approach without any statistical significance. The extracranial approach was associated with a higher risk of CSF leakage, reoperation rate to treat the CSF leakage, and the recurrence rates. The infected CSF leakage between the extracranial and intracranial approaches showed no significant difference.

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Acknowledgements

The authors would like to thank to Rahadian Indarto Susilo, M.D., Ph.D., and Achmad Fahmi, M.D., Ph.D (Department of Neurosurgery, Faculty of Medicine Universitas Airlangga – Dr. Soetomo General Academic Hospital), and Mohammad Ayodhia Soebadi, M.D., Ph.D (Department of Urology, Faculty of Medicine Universitas Airlangga – Dr. Soetomo General Academic Hospital), for their scientific advice and administrative support.

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  1. Department of Neurosurgery, Universitas Airlangga Faculty of Medicine, Dr. Soetomo General Academic Hospital, Gedung Pusat Diagnostik Terpadu (GDC) Lantai 5, RSUD Dr. Soetomo Jl. Mayjen Prof Moestopo 6-8, Surabaya, Indonesia

    Wihasto Suryaningtyas, I Putu Ananta Wijaya Sabudi & Muhammad Arifin Parenrengi

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WS, PAWS, and MAP contributed to the study conception and design. WS and PAWS performed literature search, collection, screening, and analysis. WS, PAWS, and MAP interpreted the results and assessed the risk of bias. WS wrote the draft of the manuscript. All authors critically reviewed, commented, and approved the final manuscript.

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Correspondence to Wihasto Suryaningtyas.

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Suryaningtyas, W., Sabudi, I.P.A.W. & Parenrengi, M.A. The extracranial versus intracranial approach In frontoethmoidal encephalocele corrective surgery: a meta-analysis. Neurosurg Rev 45, 125–137 (2022). https://doi.org/10.1007/s10143-021-01582-6

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