The Role of Watertight Dural Closure in Supratentorial Craniotomy: A Systematic Review and Meta-Analysis.

Abstract

The idea of watertight dural closure (WTDC) seems extremely obvious to avoid complications such as cerebrospinal fluid (CSF) leak and infection, especially in spinal and posterior fossa surgeries. Nonetheless, several studies have shown that leaving the dura open is not associated with an increased risk of complications. The aim of this systematic review and meta-analysis is to compare non-WTDC and WTDC in patients undergoing supratentorial craniotomy regarding the risk of postoperative complications. We searched PubMed, Web of Science, Embase, and Cochrane for randomized control trials and observational studies comparing non-WTDC with WTDC in patients undergoing supratentorial craniotomy. Outcomes of interest were CSF leak, overall infection, meningitis, and subgaleal fluid collection (SFC). Statistical analysis was performed using RStudio 2023.12.1 + 402. Heterogeneity was assessed using I2 statistics. Of 1541 potential articles, 7 met the inclusion criteria. The review comprised 3 randomized control trials, 1 prospective study, and 3 retrospective cohort studies. Among the 1619 patients, 766 (47.3%) and 853 (52.7%) patients were in the non-WTDC and WTDC groups, respectively. There was no significant difference in CSF leak between the non-WTDC and WTDC groups (risk ratio [RR] 1.61; 95% CI 0.68-3.77; P = .276; I2 = 0%). Furthermore, we did not find significant differences in overall infection (RR 1.62; 95% CI 0.95-2.76; P = .078; I2 = 4%), meningitis (RR 1.87; 95% CI 0.64-5.46; P = .251; I2 = 0%), and SFC (RR 1.53; 95% CI 0.64-3.65; P = .342; I2 = 52%) between the non-WTDC and WTDC groups. These findings suggest that non-WTDC is a safe method and is not associated with an increased risk of CSF leak, overall infection, meningitis, and SFC compared with WTDC.