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Decompressive Craniectomy with or Without Dural Closure: Systematic Review and Meta-analysis
Henrique L Lepine1, Gabriel Semione2, Raphael G Povoa1
1Faculty of Medicine of the University of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil.
Neurocritical Care
|August 7, 2024
Summary
Decompressive craniectomy without watertight dural closure (open-dura) shows fewer complications and shorter surgery times compared to the traditional closed-dura method. This approach is viable, with no increased risk of infection or CSF leaks.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Surgical Techniques
Background:
- Decompressive craniectomy reduces intracranial pressure in traumatic brain injury and stroke.
- Traditional procedures involve watertight dural suturing, but evidence supporting its necessity is limited.
- The open-dura (OD) approach offers a potential alternative to conventional closed-dura (CD) techniques.
Purpose of the Study:
- To compare the feasibility and outcomes of the open-dura (OD) approach versus the closed-dura (CD) technique in decompressive craniectomy.
- To evaluate complication rates, including infection and cerebrospinal fluid (CSF) leaks, between the two dural closure methods.
- To assess differences in mortality, neurological outcomes, and operation duration.
Main Methods:
- A systematic review and comparative meta-analysis of studies comparing OD and CD dural closure techniques.
- Searches conducted in Medline, Embase, and Cochrane databases.
- Primary endpoint: complication rates; secondary endpoints: infection, CSF leaks, mortality, neurological outcomes, and operation duration. Random-effects model used for analysis.
Main Results:
- The OD group showed a significantly reduced likelihood of overall complications compared to the CD group (OR 0.54, 95% CI 0.32-0.90).
- No statistically significant differences were found in infection rates, CSF leaks, mortality, or poor neurological outcomes between the OD and CD groups.
- Operation duration was significantly shorter in the OD group, with a mean reduction of 52.50 minutes.
Conclusions:
- Decompressive craniectomy using the open-dura approach is a viable alternative to traditional watertight duraplasty.
- The OD technique is associated with a lower rate of overall complications and reduced surgical time without increasing risks of infection or CSF leaks.
- This approach may lead to reduced healthcare costs and shorter procedure lengths.
