Efficacy and safety of decompressive craniectomy with non-suture duraplasty in patients with traumatic brain injury

Abstract

18Background 19 Decompressive craniectomy is an important surgical treatment for patients with severe traumatic brain 20 injury (TBI). Several reports have been published on the efficacy of non-watertight sutures in duraplasty 21 performed in decompressive craniectomy. This study aims to evaluate the effectiveness of dura closure 22 without sutures (non-suture duraplasty) in decompressive craniectomy for TBI. 23 Methods 24One hundred and six patients were enrolled at a single trauma center between January 2017 and 25 December 2018. We retrospectively collected the data and classified the patients into non-suture and 26 suture duraplasty craniectomy groups. We compared the characteristics of patients and their intra/post-27 operative findings such as operative time, blood loss, imaging findings, complications, and Glasgow 28 outcome scale. 29 Results 30There were 37 patients in the non-suture group and 69 in the suture craniectomy group. There were no 31 significant differences between the two groups with regard to general characteristics. The operative 32 time was 205 min for the suture duraplasty group and 150 min for the non-suture duraplasty group, and 33 that for the non-suture duraplasty group was significantly lesser (p=0.002). Blood loss was significantly 34 lesser in the non-suture duraplasty group (1000 mL) than in the suture duraplasty group (1500 mL, 35 p=0.028). There were no other significant differences. 36 Conclusion 37 Non-suture duraplasty involved shorter operative time and lesser blood loss when compared to suture 38 duraplasty. Other complications and prognosis were similar in both groups. Therefore, it can be 39 concluded that decompressive craniectomy with non-suture duraplasty is a safe and useful surgical 3 40 technique in patients with TBI. 4 41 130 the dura mater (i.e., 'watertight suture') because this has been thought to prevent various complications 9 131 such as infection, CSF leakage, and subgaleal fluid collection. However, the efficacy of watertight 132 suturing is not entirely known, especially in TBI cases. Recently, some authors have argued that 133 watertight suturing increases operative time and hospital costs, and the occurrence of complications is 134 similar to that in cases without watertight sutures [1, 2, 6]. Guresir et al.[1] introduced rapid closure 135decompressive craniectomy, which is not dura reconstruction, but filling of the dural defect with a 136 hemostat material. Non-suture duraplasty craniectomy is similar to rapid closure craniectomy, but uses 137 synthetic dura instead of the hemostat material to avoid adhesion in cranioplasty. This difference may 138 create higher costs for non-suture duraplasty craniectomy than rapid closure craniectomy, although 139 there may be surgical benefits such as shortened operative time due to inhibited adhesion at cranioplasty 140 subsequent to non-suture duraplasty craniectomy. 141The present study evaluated the operative time and blood loss as the comparable intra-operative 142 parameters. The non-suture duraplasty crani...

Outcome & Complications of Decompressive Craniectomy with Expansion Duroplasty in Severe Head Injury

“…Five patients with GCS between 3 and 4 post-operatively suffered problems, whereas 16 patients with GCS between 5 -8 developed issues (p-value: 0.803). Jeong et al 18 conducted a study on non-suture duroplasty performed in TBI patients as part of a DC. Non-suture duraplasty required less time to perform and resulted in less blood loss than suture duraplasty.…”