Perioperative Goal-Directed Fluid Therapy in Neurosurgical Patients: A Scoping Review of Current Evidence and Research Gaps

Background: Neurosurgical patients are sensitive to fluid imbalances in postoperative settings. Traditional fluid management has been shown to have variable outcomes. Goal-directed fluid therapy (GDFT) is a tailored approach, but its benefits are not well established in neurosurgery. Hypothesis: The aim of this study is to identify and map the existing literature on perioperative GDFT in neurosurgical patients, including study characteristics, reported outcomes, and knowledge gaps. Methods: This scoping review follows the PRISMA-ScR reporting guidelines and the Arksey and O’Malley six-stage methodological framework. A literature search was performed across three databases from January 2000 to April 23, 2025. Studies evaluating GDFT in adult neurosurgical patients were included, while studies involving pediatric populations, non-English language, case reports, or surgical procedures outside the scope of neurosurgery were excluded. Title and full-text screening were conducted independently by four reviewers. Key study characteristics were extracted and synthesized. Results: Of 62 studies identified, 23 were included after full-text screening: twenty randomized controlled trials, two systematic reviews, and one non-randomized controlled study. GDFT was associated with reduced intraoperative fluid administration, fewer postoperative complications, and shorter hospital stays, demonstrating its value in neurosurgery. Conclusions: Across studies, the protocols for GDFT varied in monitoring tools, fluid thresholds, and intervention algorithms. Limitations of the current evidence include heterogeneity in protocols and comparators, potential publication bias, and a lack of detailed reporting on functional recovery or long-term outcomes. Future research is needed to address these gaps, particularly by standardizing intervention protocols and evaluating long-term clinical outcomes across diverse neurosurgical populations.