Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies.

OBJECTIVE: The aim of the current study was to prospectively analyze complication rates and costs associated with dural closure in patients undergoing supratentorial craniotomies, randomized for watertight and adaptive dural closures.

METHODS: One hundred fifty consecutive patients with supratentorial lesions who were between 18 and 70 years of age were prospectively included. A watertight dural closure was the primary goal (Group A). Whenever this goal could not be achieved, patients were intraoperatively randomized for secondary watertight (Group B) or adaptive dural closure (Group C). Within a follow-up period of 4 weeks, study end points were the occurrence of complications such as subcutaneous fluid collections, impaired wound healing with and without cerebrospinal fluid leakage, and infection. Moreover, we analyzed costs for dural closure for each group separately.

RESULTS: Of 150 eligible patients, 13 were excluded according to predefined criteria (Group A, n = 3; Group B, n = 7; Group C, n = 3). From those patients, a primary watertight dural closure could be obtained in 44 (29.4%) patients. A secondary watertight dural closure was performed in 53 (35.3%) patients, and an adaptive dural closure was performed in 53 (35.3%) patients. Complications that were related to dural closure or wound closure were found in 7 patients in Group A, 6 patients in Group B, and 12 patients in Group C (all not significant). The mean total costs, based on time and additional material required in Group A (US $436 +/- 119) or Group B (US $681 +/- 286) were significantly greater compared with adaptive dural closure in Group C (US $213 +/- 142, P < 0.05).

CONCLUSION: In supratentorial craniotomies, an adaptive dural closure may represent a safe and cost-effective alternative to watertight dural closure.