Adaptive Non Watertight Versus Watertight Dural Closure in Supratentorial Craniotomies

Background Watertight dural closure has been taken forgranted among generations of neurosurgeons. In many situations, dura could not be primarily watertightly closed or intentionly left open during intracranial craniotomies. Objectives: To compare postoperative complications related to CSF leak after adaptive non watertight dural closure to standard watertight dural closure during supratentorial craniotomies in absence of hydrocephalus. Patients and Methods Prospective cohort study of seventy two Patients with supratentorial pathologies located in three groups according to method of dural closure,primary or secondary watertight closure and adaptive non watertight dural closure, to investigate postoperative complications related to dural closure and CSF leak. Results Postoperative complications occurred in three cases of group A, four cases of group B and six cases of group C. Subcutaneous CSF collection occurred in one case 4% (Group A), one case 5% (Group B) and two cases 8% (Group C). CSF leak occurred in one case in each group (4% in group A, 5% in group B, 4% in group C) with no need for surgical intervention. Delayed wound healing without CSF leak and with no need for surgical intervention in one case 4% (group A), one case 5% (group B), two cases 8% (group C) . Meningitis occurred only in one case 5% (group B) and one case 4% (group C). All complications were non significant between the three groups (P value 0.05). Conclusion Adaptive non watertight dural closure could be a good, safe and fast alternative to primary or secondary watertight dural closure in supratentorial craniotomies but not superior to them.