Abstract
Objectives
Duraplasty is crucial for optimal healing of the wound site and prevention of potential complications. This study focuses on the technical nuances of our developed “folding technique” for duraplasty during surgery, and the clinical implications of this technique compared to the traditional primary duraplasty technique.
Materials and Methods
Hospital records of patients who underwent intracranial surgery with synthetic dural material for duraplasty in the Department of Neurosurgery at Ankara University Faculty of Medicine between 2023 and 2024 were retrospectively evaluated. Patients were divided into two groups: those undergoing duraplasty with the folding technique (Group 1) and those undergoing primary duraplasty (Group 2). Specific criteria were used to evaluate the two groups.
Results
A total of 77 patients were included in the study, with 43 (55.8%) in Group 1 and 34 (44.2%) in Group 2. There was a significant difference between the two groups in terms of the application of craniotomy and craniectomy, with the majority of patients in the primary technique group undergoing craniotomy. Additionally, the length of hospital stay was significantly shorter in the group where the folding technique was used. No significant differences were observed in other parameters.
Conclusion
The “Folding Technique” in duraplasty is comparable to traditional primary stitching in preventing cerebrospinal fluid leakage during the waterproof stitching process, and it yields more successful results in certain aspects. The folding technique provides a safe, effective, and practical method for duraplasty.
Keywords:
Dura mater, cerebrospinal fluid, fistula
References
1Dogan I. “Inner Flap” Method in the Reconstruction of Posterior Fossa Dura: Surgical Technique and Single Center Clinical Experience. J Ankara Univ Fac Med. 2016;69:137-140.
2Cain JE, Dryer RF, Barton BR. Evaluation of dural closure closure techniques - Suture methods, fibrin adhesive sealant and cyanoacrylate polymer. Spine. 1988;13:720-725.
3Verheggen R, Schulte-Baumann l, Hahm G, et al. A New Technique of Dural Closure - Experience with a Vicryl Mesh. Acta Neurochir (Wien). 1997;139:1074-1079
4Richtsmeier JT, Flaherty K. Hand in glove: brain and skull in development and dysmorphogenesis. Acta Neuropathol. 2013;125:469-489.
5Esposito F, Angileri FF, Kruse P, et al. Fibrin sealants in dura sealing: a systematic literatüre review. PLoS One. 2016;11:e0151533.
6Attenello FJ, McGirt MJ, Garces-Ambrossi GL, et al. Suboccipital decompression for Chiari I malformation: outcome compariso of duraplasty with expanded polytetrafluoroethylene dural substitute versus pericranial autograft. Childs Nerv Syst. 2009;25:183-190.
7Williams LE, Vannemreddy PS, Watson KS, et al. The need in dural graft suturing in Chiari I malformation decompression: a prospective, single-blind, randomized trial comparing sutured and sutureless duraplasty materials. Surg Neurol Int. 2013;4:26.
8Fioravanti A, Badaloni F, Tubbs RS, et al. How I do it - The “drum skin” duraplasty technique after foramen magnum decompression for Chiari malformations. Acta Neurochir (Wien). 2023;165:3045-3050.
9Kurpad SN, Cohen AR: Posterior fossa craniectomy: an alternative to craniectomy. Pediatr Neurosurg. 1999;31:54-57.
10Çavdar S, Sürücü S, Özkan M, et al. Comparison of the Morphologic and Mechanical Features of Human Cranial Dura and Other Graft Materials Used for Duraplasty. World Neurosurg. 2022;159:e199-e207.
11Kanna K, Gnanalingham KK, Lafuente J, et al. Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? J Neurosurg. 2002;97:821-826.
