Is There a Benefit to Suture Expansile Duraplasty in Decompressive Hemicraniectomy? A Retrospective, Bicentric Cohort Study

BACKGROUND AND OBJECTIVES: Assessment of the effect of different types of dural closure on the surgical outcome after decompressive hemicraniectomy (DC).

METHODS: We retrospectively identified consecutive patients who underwent DC either with sutured expansile duraplasty or unsutured expansile duraplasty by search of the respective electronic patients' charts starting in March 2022. The primary outcome was the frequency of revision surgery. Secondary outcome measures included morbidity, mortality, Glasgow Outcome Scale-Extended (GOSE) and length of hospital stay. Indications for decompression were acute subdural hematoma, intracerebral hematoma, malignant hemispheric infarction, and refractory-raised intracranial pressure (ICP).

RESULTS: A total of 100 patients were included. Fifty were treated with sutured and unsutured duraplasty, respectively. We found no significant difference between the techniques regarding frequency of revision surgery (P = .721), morbidity (P = .071), survival after 6 months (P = .141), GOSE at 1 month postoperatively, and dichotomized GOSE scores from 1 to 4 (poor) and 5 to 8 (favorable) at last follow-up (P = .186 and P = .576) and length of hospital stay (P = .898). Secondary hemorrhages (P = .011) and secondary ICP raise (P = .011) were more frequent in the sutured group. However, the distribution of pathologies leading to DC differed significantly between the cohorts (P = .024).

CONCLUSION: Unsutured duraplasty did not lead to a higher rate of revision surgery but regarding complications, a lower rate of secondary hemorrhages and secondary ICP raise was detected in this group compared with sutured duraplasty. Owing to the retrospective design and varying indications, an assertion on the superiority of either technique is hampered.