Introduction: Decompressive craniectomy is performed to relieve elevated intracranial pressure1. Dural substitutes are often used in these procedures but there is little concensus on which substitutes to use or the utility of these substitutes in improving outcomes and reducing complications.

Methods: This systematic literature review examined original reports on outcomes with the use of dural substitutes and was intended to compare different techniques. This review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). PubMed articles were selected using the following search-terms: “duraplasty and craniectomy” or “duraplasty and cranioplasty” or “dural substitute and craniectomy” or “adhesion and craniectomy.” The reference lists of selected articles were screened for additional articles. Articles met inclusion criteria if the abstract was in English and the surgery investigated was supratentorial. Articles were excluded if they did not address outcomes or complications of the procedure.

Results: A total of 9 publications met criteria. All were retrospective cohort or case series. Outcomes of adhesion preventing dural substitutes (N= 310) were compared to conventional duraplasty (N= 219), and single layer dural substitute (N= 35). A total of 564 patients were included from 1998 to 2017. While study heterogeneity limited ability for cross-study comparison overall, within each report, the use of adhesion-preventing dural substitutes was associated with statistically significant reduction in operative time and blood loss. The majority of studies did not report an increase in complications, defined as post-cranioplasty fluid collections and infection, although Huang et a2l., found increased risk of infection with the non-absorbable dural substitute Neuro-Patch.

Conclusions: Decompressive craniectomy is a common neurosurgical procedure. Dural substitutes are increasingly used, however, there is little consensus on preferred material or procedure. This review suggests that synthetic substitutes may be associated with improved surgical outcomes. Larger, controlled studies are needed to compare individual dural substitutes and to clarify indications for each substitute.

Patient Care: This research serves to summarize the reported literature supporting duraplasty. This is the first literature review of its kind on this subject and will serve as the foundation for further clinical trials.

Learning Objectives: By the conclusion of this session participants should be able to: 1) discuss the different options of duraplasty, 2) discuss the morbidity profile of each dural substitute, 3) discuss the literature supporting duraplasty

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