Effect of Dural Substitute and Technique on Cranioplasty Operative Metrics: A Systematic Literature Review.

BACKGROUND: Cranioplasty after decompressive craniectomy can be associated with significant morbidity. Dural substitutes during the initial decompression could improve outcomes.

METHODS: We performed a systematic literature review of online peer-reviewed databases to determine the effect of dural substitutes during decompressive craniectomy on operative metrics and outcomes after subsequent cranioplasty.

RESULTS: Nine studies from 2006 to 2018 had reported the results from 922 patients undergoing autologous cranioplasty. Seven types of dural substitute were described, including biologic and synthetic materials. Compared with no graft, the use of dural substitutes was associated with significantly decreased operative times and surgical blood loss during subsequent cranioplasty. One study evaluated dual-layer substitutes and documented superior results compared with single layer. The most commonly reported complications were infection and cerebrospinal fluid leak; however, a significant reduction in complications was seen in only 1 study.

CONCLUSIONS: The use of dural substitutes was associated with superior operative metrics, complication rates, and long-term outcomes.