A Comparative Study of Watertight Dural Closure and Nonwatertight Dural Closure for Decompressive Craniectomy

Abstract Decompressive craniectomy (DC) remains a primary modality to effectively reduce elevated intracranial pressure (ICP), a correctly performed surgery can prevent cerebral complications and brain injuries caused due to refractory increased ICP. This article compares the safety and efficacy of two surgical techniques—watertight (WT) dural closure and nonwatertight (NWT) dural closure for DC. A prospective randomized comparative study was conducted from May 15, 2021 to April 15, 2022 in the neurosurgery department of a tertiary care hospital. Using the block randomization method, a total of 56 (28 patients per group: group WT including those undergoing WT dural closure and group NWT undergoing NWT dural closure) patients with indication for DC including traumatic brain injury, infarction, aneurysmal subarachnoid hemorrhage, and dural venous sinus thrombosis were included. Fifty-six randomly allocated patients were analyzed for operative characteristics and postoperative complications and for Glasgow Outcome Scale (GOS) outcomes. Compared with group WT, NWT had significantly lesser operative time. Both interventions were effective in managing the patients of traumatic brain injury. The mortality percentage was lesser in the NWT group. Despite fast surgery, the hospital stay in the NWT and WT groups were statistically similar. In the present study, GOS score was determined at 1, 2, and 3 months for determining the outcomes. GOS score improved significantly in both the groups. Statistically, the outcomes were comparable at 1 month (p = 0.105) and 3 months (p = 0.188). NWT dural closure had significantly lesser operative time as compared with WT dural closure. However, amount of blood loss, hospital stay, complications, and mortality were similar among the two groups. Even the follow-up outcome response was comparable among the two groups. It can be concluded that in supratentorial craniotomies, adaptive NWT dural closure may be a good, safe, and time-saving alternative.