Sutured versus Sutureless Dural Substitutes: Experience from a Government Tertiary Care Hospital in India

Abstract Dural substitutes have emerged as favorable alternatives to autologous grafts. This shift in approach is evident in the growing use of sutureless grafts (e.g., DuraGen) over traditional sutured options (e.g., bovine pericardial patch). This study was conducted to gain insights into the choice between the two in terms of the rate of postoperative complications. This prospective study was conducted between May 15, 2023 and January 31, 2024 at a tertiary-care government hospital in India. The patients received sutured (bovine pericardial patch) or sutureless (DuraGen patch) dural substitutes. Success in both groups was defined by the absence of postoperative complications. Wound healing was evaluated on postoperative day (POD) 3, 10, and 14. Follow-up assessments occurred at 1 and 3 months. Cerebrospinal fluid pooling was assessed by computed tomography (immediately after surgery and on POD 10) and brain magnetic resonance imaging (after 1 month). A total of 50 patients received sutured (bovine pericardial patch; n = 25) or sutureless (DuraGen patch; n = 25) dural substitutes to repair the dural defect that occurred after resection of cranial (62%) and spinal (20%) tumors. The bovine pericardial patch application was successful in 21 patients (84.0%), whereas the DuraGen patch application was successful in 23 patients (92.0%). The success rates with the bovine pericardial patch were 100% in patients with spinal tumors and patients who underwent foramen magnum decompression, 33.3% in patients with meningocele myelocystocele, and 81.8% in patients with cranial tumors. The success rates with the DuraGen patch were 80% in patients with spinal tumors and 95% in patients with cranial tumors. Sutureless grafts like DuraGen offer rapid application, reduced infection risk, and suitability for complex areas like the skull base. Sutured grafts may be preferred for larger defects due to their adaptability and inherent strength.