Advancements in Duraplasty Techniques: Exploring the Implications

A randomized comparison of two duraplasty techniques shows that duraplasty choice influences cerebrospinal fluid (CSF) leak rates, operative time, and early functional recovery after decompressive craniectomy for traumatic brain injury (TBI).

The trial was a randomized, non-blinded clinical comparison of 29 adults with TBI undergoing decompressive craniectomy, allocated to C-shaped versus linear duraplasty. Primary endpoints included postoperative CSF leakage, duraplasty operative time, length of stay, and functional outcome by Glasgow Outcome Scale (GOS).

Outcomes were assessed intraoperatively and at one month. In this small trial, the linear approach reduced mean duraplasty time (19.5 ± 3.7 vs. 11.5 ± 3.7 min, p=0.046), shortened hospital stay (15.0 ± 2.5 vs. 7.4 ± 2.0 days, p=0.038), and lowered observed CSF leak incidence (40% vs. 14.3%).

Operationally, the linear duraplasty produced about an eight-minute reduction in closure time and a faster decline in drain output by day 5. One-month functional outcome also favored the linear group (mean GOS 4.1 vs. 3.5, p=0.023). CSF leakage occurred in 6/15 in the C-shaped group versus 2/14 in the linear group.

Postoperative drain volumes and subgaleal collections were lower with the linear technique, while rates of meningitis were similar between groups (one case each), leaving infection differences inferential rather than proven. The linear incision simplified durotomy closure, reduced the need for patch material, and shortened OR time—effects that can influence scheduling and neurocritical care resource use.

These randomized data recalibrate expectations about duraplasty choice during decompressive craniectomy for TBI by demonstrating measurable benefits in efficiency, leak control, and early functional outcome.