• World Neurosurg · Jun 2018

    Watertight Dural Closure in Pediatric Craniotomies-Is It Really Necessary?

    • Jonathan Roth, Haggai Benvenisti, and Shlomi Constantini.
    • Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. Electronic address: jonaroth@gmail.com.
    • World Neurosurg. 2018 Jun 1; 114: e743-e746.

    BackgroundDural closure after intracranial procedures is considered crucial to reduce postoperative complications such as pseudomeningocele (PM), cerebrospinal fluid (CSF) leaks, hydrocephalus, and infections. However, watertight dural closure (WTDC) is often difficult to achieve, and dural substitutes often are used. We describe our experience with non-WTDC in children.MethodsData were collected retrospectively. Redo and craniectomy cases were excluded. Collected data included demographics, surgical etiology, various radiologic parameters, ventricular opening, usage of drains and shunts, dural closure technique, and complications.ResultsIn total, 163 cases aged 3 months to 18.5 years (90 ± 56 months) were included. Main surgical indications were tumors (120, 74%) and epilepsy (29, 18%). In total, 122 (74%) cases were supratentorial. The ventricular system was opened in 69 (42%) cases. In 145 (89%) cases, a non-WTDC was performed. Fibrin glue was used in 22 (13%) cases. In 156 cases (96%), a dural substitute was used. One patient (0.6%) had a CSF leak. At 3 months, 20% had a radiologic PM but only 8.4% were noticed clinically. At 1 year, 7.7% had a radiologic PM but only 3% were noticed clinically. Overall, 3% needed a PM tap, and 15 patients (9%) underwent CSF diversion procedures. There were no infections. The only factor significantly associated with PM or a need for CSF surgery was an infratentorial location.ConclusionsNon-WTDC after cranial surgery in children was associated with a low rate of clinically significant PM, infections, leaks, and hydrocephalus. Non-WTDC is fast and reduces the need to harvest additional tissue, thus minimizing the surgical incision.Copyright © 2018 Elsevier Inc. All rights reserved.

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