Comparative analysis of the efficiency of dura mater defect repair in cerebral surgery

Abstract

We aimed to study the efficacy of various substitutes in repair of dura mater defects. The study included patients with various intracranial pathologies who were operated on at the Neurosurgery Clinic of the Military Medical Academy in the period between 2010 and 2017, and who underwent repair of the DM during surgery. In surgery for the supratentorial structures, patient autogenous tissues, grafted non-resorbable materials, or applicable collagen matrices were used as substitutes. Depending on the type of substitute material, patients were divided into groups to assess the efficacy of DM closure by comparing the rate of postoperative liquorrhea. In surgery for the posterior cranial fossa (PCF), applicable dural substitutes were not used; in this cohort, the efficacy of autogenous tissues and synthetic materials was compared. In 232 patients, the total rate of liquorrhea was 23.7%. In supratentorial surgery (175 cases), the use of autogenous tissues (n=73), synthetic materials (n=42), and collagen matrices (n=60) was associated with CSF exfusion in 13 (17.8%), 13 (31.0%) and 16 (26.7%) cases, respectively; in statistical analysis, these results were comparable (p>0.05). In PCF surgery (57 cases), the use of autogenous tissues (n=34) significantly more effective (p=0.021) prevented liquorrhea compared to synthetic materials (n=23): complications occurred in 4 (11.8%) and 9 (39.1%) cases, respectively. If a DM defect is located supratentorially, the choice of a dural substitute affects the rate of CSF exfusion and related complications. The use of autogenous tissues in PCF surgery statistically significantly reduces the rate of liquorrhea compared to that of synthetic materials.