• Burak Sade, Soichi Oya, and Joung H Lee.
• Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
• J. Neurosurg. 2011 Mar 1; 114 (3): 714718714-8.

ObjectThere are various schools of thought when it comes to dural reconstruction following meningioma surgery, which are largely based on the personal experience of the individual surgeons. The authors' aim in this study was to review different dural reconstruction techniques, with an emphasis on their experience with the synthetic onlay dural graft technique.MethodsThe medical records of 439 consecutive patients who were surgically treated for an intracranial meningioma over a period of 7 years, and for whom dural reconstruction was performed using the onlay dural graft DuraGen (Integra Neurosciences) were reviewed retrospectively. The most common tumor location was the convexity (27.6%), and 12% of the patients had undergone previous surgery. Complications related to the closure technique and/or closure material, such as CSF leakage from the incision, rhinorrhea, or infectious or chemical meningitis were reviewed.ResultsA CSF leak was encountered in 2 patients (0.4%), and 10 patients (2.3%) experienced graft-related complications in the form of chemical meningitis, cerebritis, and accumulation of extraaxial fluid. Infectious complications were seen in 4 patients (0.9%; bacterial meningitis, osteomyelitis, epidural abscess). None of the patients had pseudomeningocele that required a second intervention.ConclusionsIn the authors' experience, the incidence of CSF leakage following non-watertight reconstruction of the dura mater in meningioma surgery performed using dural onlay graft was 0.4%. Graft-related complications occurred in 2.3%. These figures compare favorably to the majority of the series in which watertight dural closure is described and emphasized.

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