Dura Closure Tactics to Prevent CSF Leakage in Microvascular Decompression Surgery

(1) Background: Achieving a complete and secure dural closure to prevent cerebrospinal fluid (CSF) leakage is a critical concern in microvascular decompression (MVD). Proper dural closure minimizes complications, such as infections caused by CSF leakage. This study introduces a novel three-step dural suturing method, termed the "triple-layer closing technique". (2) Methods: From September 2020 to March 2023, a total of 475 patients underwent MVD surgery at our institution, all of whom received dural closure using the triple-layer closing technique. This technique incorporates three layers: Duragen^® (synthetic dura, Integra Lifesciences), TachoSil^® (collagen matrix, Nycomed), and polymethyl methacrylate (PMMC) bone cement. Postoperative complications, including CSF leakage and infections, were retrospectively analyzed. (3) Results: CSF leakage was observed in five patients (1.1%), all of whom presented with CSF rhinorrhea and radiological evidence of effusion within the mastoid air cells. These patients were successfully treated with lumbar drainage, and none required reoperation. No other postoperative infections or complications were reported. (4) Conclusions: The triple-layer closing technique, utilizing Duragen^®, TachoSil^®, and PMMC bone cement, is an effective and reliable method for dural closure. This technique significantly reduces the risk of CSF leakage and surgical site infections, enhancing postoperative outcomes in MVD procedures.