The Comprehensive Systematic Review of Efficacy of Minimally Invasive Techniques in Neurotrauma Surgery

Abstract

Introduction: Neurotrauma, encompassing traumatic brain injury (TBI) and spinal trauma, represents a leading cause of global mortality and disability. Traditional open surgical approaches, while effective, are associated with significant morbidity. The advent of minimally invasive surgical (MIS) techniques promises to reduce surgical trauma while maintaining or improving clinical outcomes (Sahuquillo & Dennis, 2019).

Methods: This comprehensive systematic review screened and analyzed 80 studies published between 2001 and 2025, including randomized controlled trials, cohort studies, and meta-analyses. The review focused on patients with acute neurotrauma requiring surgical intervention, comparing MIS techniques (e.g., endoscopic surgery, percutaneous fixation, stereotactic puncture, decompressive craniectomy variants) against traditional open surgery or conservative management. Data extraction covered study characteristics, techniques, clinical outcomes (mortality, functional scores), operative outcomes, and complications (Danfeng Zhang et al., 2017).

Results: MIS techniques demonstrated significant and consistent benefits. For intracranial trauma, decompressive craniectomy (DC) reduced mortality by 34-41% compared to medical therapy (Risk Ratio [RR] 0.57-0.66). Cisternostomy showed superior mortality outcomes (Odds Ratio [OR] 0.348). Endoscopic evacuation for intracerebral hemorrhage (ICH) improved functional independence (RR 1.62) and achieved higher hematoma evacuation rates (84-87%). For spinal trauma, MIS approaches significantly reduced blood loss (mean difference -155 to -200 mL), postoperative pain, and hospital length of stay (mean reduction 3.34 days) while achieving equivalent radiological outcomes (Wei Zhang et al., 2016; Mohammad Daher et al., 2025).

Discussion: The efficacy of MIS is context-specific. DC robustly reduces mortality but with a nuanced effect on functional recovery, heavily influenced by age and timing. Endoscopic techniques for ICH provide superior outcomes. In spinal trauma, MIS offers clear perioperative advantages. The evidence highlights a trade-off between the robust mortality benefit of certain invasive decompressions and the superior functional recovery and reduced morbidity associated with less invasive evacuation techniques.

Conclusion: Minimally invasive techniques in neurotrauma surgery provide substantial benefits, including reduced mortality, improved functional recovery, decreased perioperative morbidity, and shorter hospital stays. The choice of technique must be individualized based on pathology, injury severity, patient age, and surgical expertise. Future research should focus on standardized outcome measures, long-term functional assessments, and cost-effectiveness analyses.