Risk Factors for Cerebrospinal Fluid Leakage after Craniotomy and the Efficacy of Dural Sealants Application versus Dural Suturing Alone

Abstract

Objective: Cerebrospinal fluid (CSF) leakage is a latent risk of cranial surgery with dural opening. We hypothesize that addi-tion of Duraform on top of dural suture reduces postoperative CSF leakage in cranial surgery with dural opening. The aim of this study was to assess the efficacy of dural sealants application against dural suturing alone and risk factors for CSF leakage and potentially related complications after craniotomy. Methods: A retrospective review of patients undergoing craniotomy with dural opening over a 3-year period at a single in-stitution was performed. We compared our standard dural closure by continuous running suture alone to the same closure with the addition of Duraform on top of the suture. Logistic regression analyses were performed to determine the variables associated with CSF leakage and infection. Results: Three hundred sixty-three patients were included with mean follow-up of 13±standard deviation (SD) of 9.2 months in the study group (n=117) and 18±11.2 months in the control group (n=246). Postoperative CSF leaks were identified in 6 patients (5.1%) in the Duraform application group and in 31 (12.6%) in the control group. Multivariate logistic regression modeling identified diabetes mellitus and infratentorial operative location as significant predictors of CSF leak. Conclusion: This study shows that addition of dural sealant upon the dural suture reduces postoperative CSF leak and in-fection after elective craniotomy. Its clinical use for dural augmentation was safe and not related to adverse events. Diabetes mellitus and infratentorial operative location were identified as risk factors for postcraniotomy CSF leak.