Frontiers in surgery · 2026
Comparative evaluation of two dural closure techniques for U-shaped incisions: sealing efficacy vs. site-specific infection risk.
СтатьяНазвание и аннотация: Перевод в очереди
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Wang Yu, Zhao Chang-Zhi, Zhang Kai-Long, Chen Yi-Xiao, Li Ao, Yin Jie, Long Fei, Wang Qi-Hong
Аннотация
OBJECTIVE: This study aimed to compare the outcomes of direct suturing (Method 1) and pericranium-assisted suturing (Method 2) for U-shaped dural incisions, with a specific focus on site-specific differences in cerebrospinal fluid (CSF) leak and postoperative infection.
METHODS: In this retrospective cohort, 172 patients undergoing repair of U-shaped dural incisions were analyzed. Based on intraoperative feasibility, patients underwent either Method 1 (n = 94) or Method 2 (n = 78). Primary and secondary outcomes were CSF leak and postoperative infection rates, respectively. Subgroup analyses were stratified by surgical site (supratentorial vs. infratentorial).
RESULTS: The incidence of CSF leak was low and comparable between the two methods, regardless of surgical site (Method 1: 7.14% supratentorial vs. 7.69% infratentorial, P = 1.00; Method 2: 4.17% vs. 3.33%, P = 1.00). Re-repair rates were similarly low across all groups. However, Method 2 was associated with a significantly higher overall infection rate in the infratentorial compartment compared to supratentorial surgeries (23.33% vs. 6.25%, P = 0.039). Sub-analysis revealed this was primarily driven by a higher incidence of incision infection/delayed healing in the infratentorial group (16.67% vs. 2.08%, P = 0.028), whereas meningitis rates were comparable. Multivariable analysis confirmed the surgical site itself was not an independent risk factor for infection.
CONCLUSION: Both direct and pericranium-assisted suturing are effective in preventing CSF leak for U-shaped dural incisions. However, the pericranium-assisted technique carries a significantly increased risk of incision-related infections in the infratentorial region. Clinical decision-making must therefore balance the reliable sealing capability of pericranium-assisted repair against its site-specific infection profile, particularly in complex posterior fossa surgeries.
METHODS: In this retrospective cohort, 172 patients undergoing repair of U-shaped dural incisions were analyzed. Based on intraoperative feasibility, patients underwent either Method 1 (n = 94) or Method 2 (n = 78). Primary and secondary outcomes were CSF leak and postoperative infection rates, respectively. Subgroup analyses were stratified by surgical site (supratentorial vs. infratentorial).
RESULTS: The incidence of CSF leak was low and comparable between the two methods, regardless of surgical site (Method 1: 7.14% supratentorial vs. 7.69% infratentorial, P = 1.00; Method 2: 4.17% vs. 3.33%, P = 1.00). Re-repair rates were similarly low across all groups. However, Method 2 was associated with a significantly higher overall infection rate in the infratentorial compartment compared to supratentorial surgeries (23.33% vs. 6.25%, P = 0.039). Sub-analysis revealed this was primarily driven by a higher incidence of incision infection/delayed healing in the infratentorial group (16.67% vs. 2.08%, P = 0.028), whereas meningitis rates were comparable. Multivariable analysis confirmed the surgical site itself was not an independent risk factor for infection.
CONCLUSION: Both direct and pericranium-assisted suturing are effective in preventing CSF leak for U-shaped dural incisions. However, the pericranium-assisted technique carries a significantly increased risk of incision-related infections in the infratentorial region. Clinical decision-making must therefore balance the reliable sealing capability of pericranium-assisted repair against its site-specific infection profile, particularly in complex posterior fossa surgeries.