Dural repair in cranial surgery is associated with moderate rates of complications with both autologous and non-autologous dural substitutes.

Dural repair in cranial surgery is associated with moderate rates of complications with both autologous and non-autologous dural substitutes.

World Neurosurg. 2018 Jan 25;:

Authors: Azzam D, Romiyo P, Nguyen T, Sheppard JP, Alkhalid Y, Lagman C, Prashant GN, Yang I

Abstract
OBJECTIVE: Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery.
METHODS: The PubMed database was systematically searched to identify studies published over the last decade (2007 to 2017) that described duraplasty procedures. Clinical data were disaggregated and analyzed for the comparisons of biological versus synthetic grafts.
RESULTS: A total of 462 cases were included in the quantitative synthesis. Overall, the most common indication for duraplasty was tumor resection (53%). Allografts were more frequently used in decompression for Chiari malformations compared to xenografts and synthetic grafts (P < 0.001). Xenografts were more frequently used in decompressive hemicraniectomy procedures for evacuation of acute subdural hematomas over allografts and synthetics (P < 0.001). Synthetic grafts were more frequently used in tumor cases than biological grafts (P = 0.002). The cumulative complication rate for dural substitutes of all types was 11%. There were no significant differences in complication rates between the three types of dural substitutes.
CONCLUSIONS: Dural substitutes are commonly used to ensure dural closure in a variety of cranial procedures. This study provides greater insight into duraplasty practices and highlights the low complication rate associated with the procedure. Future studies are needed to determine the safety and efficacy of such procedures in larger prospective cohorts.

PMID: 29374609 [PubMed - as supplied by publisher]

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