Postoperative complications associated with dural substitutes in suboccipital craniotomies

Dural replacements are used in cranial surgery when primary closure of native dura is not possible. The goal is to recreate a watertight barrier to prevent cerebrospinal fluid leakage with few associated complications. We reviewed a single-institution experience with a variety of dural substitutes in posterior fossa neurosurgery, for which higher complication rates are well described.

Patients were screened for suboccipital posterior fossa neurosurgery between November 2005 and April 2007. Surgical logs were reviewed for diagnosis, procedure, and use of dural replacement. Clinical courses were reviewed for hydrodynamic complications, including delayed hydrocephalus, clinically significant pseudomeningocele, aseptic meningitis, and persistent cerebrospinal leakage.

One hundred twenty-eight patients were included, and a dural replacement was used in 106. Overall, the complication rate was 21.9% (28 patients). Complications were seen for acellular human dermis in 33.3%, for collagen matrix in the original formulation in 18.2%, for the reformulation in 16.9%, for the suturable formulation in 50%, for nonautologous materials in 24%, and for no dural replacement in 16.7%. Univariate and multivariate analysis demonstrated that hydrodynamic complications were associated with use of the suturable collagen matrix (odds ratio, 10.8; 95% confidence interval, 2.5-46.1; P = 0.0014) and trended with use of acellular human dermis (odds ratio, 4.6; 95% confidence interval, 0.9-23.1; P = 0.06).

The increased risk of hydrodynamic complications associated with suboccipital neurosurgery is modified by choice of dural replacement. Similar complication rates were seen for most materials with a variety of primary abnormalities, with the exception of suturable bovine collagen matrix, with hydrodynamic complications in 50% of patients.