Safety and efficacy of clip-assisted dural closure in spinal and cranial surgery: a systematic review and meta-analysis
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Updated: Jul 9, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Abdulrahim Saleh Alrasheed1, Saleha Khan2, Ajwan Abdulmuhsen Alhassan3
1Department of Neurosurgery, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia. 221414880@student.kfu.edu.sa.
Purpose:
Dural closure is an essential step in both spinal and cranial surgeries, following either intentional dural opening or accidental durotomy. While primary repair remains the gold standard for dural closure, it may not always be feasible, especially in minimally invasive spine surgeries and skull base defects. Moreover, it is associated with a high failure rate. This meta-analysis assessed the safety and efficacy of clip-based dural closure in spinal and cranial procedures.
Methods:
A comprehensive literature review was conducted through PubMed, Medline, Scopus, and Web of Science databases to identify eligible studies based on predefined eligibility criteria. Data on cerebrospinal fluid (CSF) leakage, infection, reoperation, and CSF leakage-related complications were extracted and pooled using a random-effects model. Subgroup analyses were performed to evaluate outcomes according to clip type and patient population. Meta-regression analyses were also conducted.
Results:
In spine surgery, postoperative CSF leakage occurred in 7% of cases (95% CI 0.04-0.12), with higher rates in adults (11%; 95% CI 0.09-0.14) compared to pediatric patients (1%; 95% CI 0.00-0.07). A statistically significant difference between subgroups was observed. Postoperative infections occurred in 5% of cases (95% CI 0.03-0.10) with a higher incidence in adults (10%; 95% CI 0.07-0.14) compared with children (2%; 95% CI 0.00-0.08), without significant variation by clip type. The pooled reoperation rate was 5% (95% CI 0.02-0.10), and CSF leakage-related complications occurred in 12% of cases (95% CI 0.03-0.40). In cranial surgery, CSF leakage and postoperative infection occurred in 8% (95% CI 0.04-0.16) and 7% (95% CI 0.01-0.53) of cases, respectively.
Conclusion:
Clip-based dural closure is a quick, safe, and effective technique, especially in minimally invasive spine surgery and skull base defects. This approach may be useful in preserving dural integrity and reducing operative time. While representing a promising alternative to suturing techniques, further randomized controlled trials are warranted to assess its long-term outcomes.
