A comparative analysis of early postoperative outcomes of autologous pericranium versus high-density polypropylene in cranial duraplasty in a tertiary care center in Central India.

BACKGROUND AND

OBJECTIVES

Duraplasty is commonly required when primary dural closure is not feasible during cranial surgery. Although both autologous and synthetic dural substitutes are widely used, high-quality prospective data comparing their early postoperative safety remain limited. This study aimed to compare early postoperative complication rates following cranial duraplasty using autologous pericranium versus high-density polypropylene (G-Patch).

METHODS

This prospective randomized comparative study enrolled 121 consecutive patients undergoing cranial duraplasty at a tertiary care center between January and December 2021. Following exclusion of patients who died within 30 days postoperatively, 100 patients (50 per group) were included in the final analysis. Patients were allocated to receive either autologous pericranium (n = 50) or high-density polypropylene (G-Patch) (n = 50) using a standardized surgical technique. The primary outcome was the occurrence of any postoperative complication within 30 days, including cerebrospinal fluid leak, wound infection, and subdural empyema. Effect estimates were expressed as odds ratios (OR) with 95% confidence intervals (CI), and a limited adjusted analysis was performed as a sensitivity assessment.

RESULTS

Traumatic brain injury and intracranial space-occupying lesions were the most common indications for surgery. Most patients in both groups had an uneventful postoperative course. Early postoperative complications occurred in 26% of patients in the synthetic graft group and 12% in the autologous group. The unadjusted odds ratio for any complication with synthetic graft use was 2.58 (95% CI: 0.88-7.54; p = 0.08). After adjustment for primary diagnosis, graft type remained a non-significant predictor of complications. No consistent associations were observed between postoperative complications and comorbidities or substance use in exploratory analyses.

CONCLUSION

In this prospective randomized cohort, both autologous pericranium and high-density polypropylene demonstrated acceptable short-term safety profiles. However, given the limited sample size, imbalance in underlying diagnoses, and short follow-up, these findings should be interpreted with caution and should not be considered evidence of equivalence between graft materials. Further studies with larger sample sizes, stratified analyses, and long-term outcomes are required.

TRIAL REGISTRATION: This investigator-initiated pragmatic randomized study was not prospectively registered in a clinical trial registry.