SynthesisActa neurochirurgica2026
Outcomes of post-operative drain use after cranioplasty surgery - a systematic review and meta-analysis.
Synthesis in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
17 authors.
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Abstract
backgroundCranioplasty restores cranial integrity following decompressive craniectomy or skull trauma. Despite its reconstructive benefits, post-cranioplasty complication rates are high. Post-operative drainage has been proposed to mitigate these risks, yet its effectiveness remains uncertain. This study evaluates the impact of post-cranioplasty drain insertion on surgical outcomes.
methodsA systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL Library was conducted in accordance with PRISMA guidelines (PROSPEROID:CRD420251030365). Studies reporting cranioplasty outcomes with post-operative drainage were selected. Primary outcomes were complication rates, including infection, haemorrhage, and cerebrospinal fluid (CSF) leak.
resultsFour studies met the inclusion criteria, comprising 522 patients (mean age 43.7 years) who underwent cranioplasty-282 with post-operative drainage and 240 without. Following decompressive craniectomy, the most common indications for cranioplasty were traumatic brain injury (196/514, 38.1%), vascular causes (187/514, 36.4%), and infection (25/514, 4.9%). All studies reported subgaleal drain use, with one study (25%) using epidural drains in an unspecified number of patients. The overall post-operative complication rate was 75/522 (14.4%), occurring in 23/282 drained patients (8.2%) and 52/240 (21.7%) undrained patients. A meta-analysis comparing post-operative complication rates across all studies between patients with and without post-cranioplasty drainage yielded a pooled risk ratio (RR) of 0.51 (95% CI: 0.21-1.24, p = 0.095).
conclusionsThe results suggest post-cranioplasty drainage does not significantly alter complication rates. However, heterogeneity in drainage protocols limits attribution of outcomes to specific modalities. Going forward, moderated prospective trials are needed to establish standardised post-cranioplasty drainage protocols.
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