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Dural tenting sutures in pediatric neurosurgery
1Department of Surgery (Neurosurgery), The University of Colorado Health Sciences Center and Department of Neurosurgery of The Children's Hospital, Denver, Colorado, USA.
Pediatric Neurosurgery
|September 10, 1998
Summary
Dural tenting sutures are rarely needed in pediatric cranial surgery, with most patients not requiring them for epidural bleeding. Prophylactic use of these sutures in children is not supported by compelling evidence.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Surgical Techniques
Background:
- Epidural bleeding is a potential complication following cranial operations.
- Dural tenting sutures are a surgical technique used to control bleeding.
- The routine prophylactic use of dural tenting sutures in pediatric neurosurgery is debated.
Purpose of the Study:
- To evaluate the necessity and efficacy of dural tenting sutures in pediatric cranial surgery.
- To determine the rate of epidural bleeding requiring dural tenting sutures.
- To assess the incidence of postoperative epidural hematoma in children undergoing cranial operations.
Main Methods:
- Retrospective analysis of 329 consecutive pediatric cranial operations.
- Selective use of dural tenting sutures for epidural bleeding control.
- Documentation of suture indication, postoperative complications, and reoperations.
Main Results:
- Dural tenting sutures were used in only 4.8% of cases for active epidural bleeding.
- The vast majority (95.2%) of patients did not require dural tenting sutures.
- Only one patient (0.3%) required reoperation for epidural hematoma, later found to have hemophilia.
Conclusions:
- Dural tenting sutures are infrequently required for epidural bleeding in pediatric cranial surgery.
- There is no compelling evidence to support the routine prophylactic use of dural tenting sutures in children.
- Selective use of dural tenting sutures based on intraoperative findings is a reasonable approach.