A Multilayered Dural Repair Technique Using Duragen for Early Cranioplasty Following Decompressive Craniotomy

Abstract

Decompressive craniotomy is a neurosurgical emergency procedure in which a large skull bone is removed and the dura matter is extensively opened. Duraplasty is required to avoid cerebrospinal fluid (CSF) leakage during the decompressive craniotomy. DuraGen^® is a safe and effective type I collagen matrix graft, which is frequently used in decompressive craniotomy procedures. Since DuraGen^® does not require labor-intensive suturing, the operative time is shortened by DuraGen^® closure with sufficient tightness preventing CSF leakage. Recently, early cranioplasty is preferred to achieve efficient rehabilitation after decompressive craniotomy. Although evidence of efficacy and safety of DuraGen^® has been increasing in the management of duraplasty, no reports have previously discussed the condition of DuraGen^® during the second surgery (cranioplasty) at this early timing. DuraGen^®-derived neodura develops a mature dura 1 year post its placement, and the neodura remain fragile at this early time point. A deconstructed fragile neodura may result in postoperative CSF leakage. Here, we illustrated a multilayered dural repair technique with DuraGen^® to avoid disruption of the fragile neodura during early cranioplasty.