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Watertight Dural Closure in Pediatric Craniotomies-Is It Really Necessary?

Jonathan Roth1, Haggai Benvenisti1, Shlomi Constantini1

  • 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

World Neurosurgery
|March 20, 2018
PubMed

Insights

Non-watertight dural closure (non-WTDC) in pediatric cranial surgery is safe and effective. This approach resulted in low rates of clinically significant complications like pseudomeningocele (PM) and cerebrospinal fluid (CSF) leaks.

Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Surgical Complications

Background:

  • Dural closure is critical after intracranial procedures to prevent complications such as pseudomeningocele (PM), cerebrospinal fluid (CSF) leaks, hydrocephalus, and infections.
  • Achieving watertight dural closure (WTDC) can be challenging, often necessitating the use of dural substitutes.
  • This study evaluates the outcomes of non-WTDC in pediatric patients.

Purpose of the Study:

  • To assess the safety and efficacy of non-watertight dural closure (non-WTDC) in pediatric cranial surgery.
  • To determine the incidence of postoperative complications associated with non-WTDC.
  • To identify factors influencing outcomes in pediatric patients undergoing non-WTDC.

Main Methods:

  • Retrospective data collection from 163 pediatric patients (3 months to 18.5 years).
  • Exclusion of redo and craniectomy cases.
  • Analysis of demographics, surgical indications, dural closure techniques, and postoperative complications.

Main Results:

  • Non-WTDC was performed in 89% of cases, with dural substitutes used in 96%.
  • A low rate of CSF leak (0.6%) and clinically significant PM (3% at 1 year) was observed.
  • No infections occurred; infratentorial location was the only factor associated with PM or need for CSF surgery.

Conclusions:

  • Non-WTDC in pediatric cranial surgery is associated with a low incidence of clinically significant pseudomeningocele, infections, leaks, and hydrocephalus.
  • This technique is time-efficient and minimizes surgical incision by avoiding the need for additional tissue harvesting.
  • Non-WTDC represents a viable and safe alternative for dural closure in pediatric neurosurgery.
Abstract

Keywords:
CSF leakChildrenCraniotomyDura closureHydrocephalusInfectionPseudomeningocele

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