Value of stellate dural incisions without duraplasty for fast closure in decompressive craniectomy

Abstract

Background
Decompressive craniectomy (DC) is always a familiar rescue procedure in refractory intracranial hypertension. However, controversy still exists regarding the best method of dural opening while performing DC.


Methods
A mixed retrospective-prospective comparative cohort study included 59 patients with refractory intracranial hypertension who underwent DC over 3 years. Retrospectively, 38 patients underwent classic closure DC (CCDC) with duraplasty from January 2022 to December 2023 (control group) and 21 patients were prospectively collected as (study group) from January 2024 to January 2025 and underwent fast-closure DC (FCDC) using stellate dural incisions (SDIs) technique without duraplasty. The 2 groups were compared to evaluate the impact of SDIs technique on surgical time; intraoperative brain stuffing; postoperative complications; hospital stay; clinical recovery and feasibility of late cranioplasty.


Results

Operative time was about 44 min shorter among patients of FCDC group (
p
 < 0.001). Increased risk of “brain stuffing” was reported among CCDC group patients 89.5% versus 0% in FCDC group (
P
 < 0.001). Hospital stay was significantly shorter among patients of FCDC group (
P
 = 0.028). Incidences of surgical complications (wound infection, cerebrospinal fluid (CSF) leak, subdural hygroma, and subdural fluid collections) and the need for re-surgery showed no statistical significance between the 2 groups. In spite not statistically significant, a lower mortality rate and better clinical recovery were observed among patients in FCDC group.



Conclusions
SDIs technique without duraplasty seems to be a feasible step for fast-closure DC. Our study technique was superior in reducing surgical time and avoiding intraoperative brain stuffing without increased risk of postoperative complications. Moreover, it was associated with shorter hospital stay, lower mortality rate, and higher incidence of clinical recovery.