Certainty in Watertight Dural Closure for the Reduction of CSF leakage
Cerebrospinal fluid (CSF) leakage is a widely recognized complication after neurosurgical procedures. It represents a significant patient burden, resulting in increased morbidity, prolonged hospital stays, possible surgical revisions, and enhanced costs. Incidence rates vary depending on age, indication, location of surgery and underlying pathology, but in total CSF leakage occurs in 4-32% of surgical cases.
Achieving watertight dural closure to provide effective control of CSF leakage is a challenge. A puncture from a single needle is sufficient to cause leakage, and during prolonged operative procedures, the fragile dura mater shrinks due to dehydration, further complicating closure.
Effective dural sealants should reduce the risk of CSF leakage after cranial surgery by enhancing dural closure. However, a recent review showed that existing commercially available dural sealants have not proven to significantly reduce post-operative CSF leakage compared to suturing alone (8.2% versus 8.4% respectively).
