Comparative effectiveness of dural sealants versus conventional dural closure methods in cranial neurosurgery: a systematic review and meta-analysis.

Watertight closure is essential in neurosurgery. The efficacy and risks of dural sealants compared to traditional methods remain controversial, especially regarding complications such as cerebrospinal fluid leak or infections.We performed a systematic review and meta-analysis of data from observational and randomized clinical trials (RCTs) found in PubMed, Cochrane, and Embase, comparing the benefits and reduction of complications between the use of dural sealants and traditional methods in craniectomy.Six studies, comprising 1,761 adult patients undergoing craniectomy, were included. Primary watertight closures with dural sealants were evidenced in 952 (54.06%), and through the conventional method (primary sutures), in 809 (45.95%) of the participants studied. Overall, the use of dural sealants were associated with a reduction in the rate of complications in the primary outcomes, such as cerebrospinal fluid leak s (RR 0,40; CI 0.25 to 0.62; p < 0.0001) and general infections (RR 0,50; CI 0.31 to 0.80; p = 0,004). However, no significant differences were evidenced related to secondary outcomes, such as the production of epi-subdural hematomas, hydrocephalus and reinterventions.The use of dural sealants-including fibrin-based adhesives, collagen-thrombin hemostatic agents, fibrin sealants, and PEG hydrogels-as adjuncts to dural closure is associated with a significant postoperative reduction in cerebrospinal fluid leakage and overall infection rates in adult patients undergoing craniectomy.