Postoperative Outcomes of Minimally Invasive Versus Open Craniotomy in Patients With Intracranial Tumors: A Systematic Review

Background: The comparative efficacy and safety of minimally invasive craniotomy (MIC) versus open craniotomy (OC) for brain tumor resection remains a pivotal clinical question. While MIC techniques aim to reduce surgical morbidity, a comprehensive synthesis of high-quality evidence is needed to guide surgical decision-making. Objective: This systematic review aims to compare postoperative recovery, complication rates, and functional outcomes between MIC and OC in patients undergoing resection of intracranial tumors. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials and comparative observational studies published between 2019-2024. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 and Newcastle-Ottawa tools. Results: Eight studies (n=1,823 patients) were included. MIC was associated with a significant reduction in estimated blood loss (mean difference: 150-275 mL, p<0.05) and length of hospital stay (reduction of 1.5-3.2 days, p<0.01) compared to OC. Complication rates, particularly for surgical site infection, were consistently lower in the MIC group. Crucially, there was no significant difference in the rate of gross total resection between the two approaches. Conclusion: For appropriately selected intracranial tumors, minimally invasive craniotomy demonstrates superior perioperative outcomes compared to open craniotomy, including reduced blood loss, shorter hospitalization, and fewer complications, without compromising the extent of tumor resection. These findings support the selective use of MIC, though further high-quality randomized trials are warranted to strengthen the evidence base.