Comparative analysis of the efficacy and safety of dural sealants in preventing complications after craniotomy: a systematic review and Bayesian network meta-analysis.

PURPOSE: The efficacy and safety of various dural sealants for dural closure have been evaluated in randomized controlled trials (RCTs). However, their associations with postcraniotomy complications remain to be compared.

METHODS

A Bayesian network meta-analysis (BNMA) was designed on the basis of studies published in PubMed, Embase, the Cochrane Library, Scopus, and Web of Science through July 9, 2025. Quality assessment was conducted using the National Institutes of Health (NIH) scale. BNMA was performed in R 4.5.1 with the "GeMTC" package, with SUCRA values and league tables generated to display comprehensive pairwise comparisons among different sealants. The certainty of evidence for each network estimate was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework.

RESULTS

Eleven studies (3094 patients who underwent craniotomy) were included. TissuePatchDural (RR = 0.03, 95% CrI (0.0007, 0.42), SUCRA = 90.52%), autologous materials (RR = 0.09, 95% CrI (0.003, 0.69), SUCRA = 73.07%) and synthetic hydrogels (RR = 0.16, 95% CrI (0.04, 0.48), SUCRA = 59.68%) had 95% CrIs excluding 1, suggesting a lower risk of postcraniotomy cerebrospinal fluid leakage than for conventional closure alone. Autologous materials showed a favorable probability for meningitis prevention (RR = 0.13, 95% CrI (0.02, 0.74), SUCRA = 82.70%). The SUCRA values indicated favorable probabilities for TissuePatchDural to prevent surgical site infection and pseudomeningocele and for autologous materials to reduce the risk of unplanned interventions, although these secondary outcomes lacked statistical significance.

CONCLUSION

The results of this BNMA suggest that compared with conventional closure alone, TissuePatchDural has a greater probability of reducing cerebrospinal fluid leakage, whereas autologous materials showed favorable efficacy signals for postoperative meningitis.