title: The incidence of complications in elective cranial neurosurgery associated with dural closure material.
abstract: OBJECTIVE
  Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak.
  
  
  METHODS
  A retrospective, consecutive cohort study of adult patients undergoing elective craniotomy was established between April 2010 and March 2011 at a single center. Exclusion criteria consisted of trauma, bur hole placement alone, and temporary CSF fluid diversion.
  
  
  RESULTS
  Three hundred ninety-nine patients were included (mean follow-up 396.6 days). Nonautologous (synthetic) dural substitute was more likely to be used (n = 106) in cases of reoperation (p = 0.001). Seventeen patients developed a surgical site infection and 12 patients developed a CSF leak. Multivariate logistic regression modeling identified estimated blood loss (OR 1.002, 95% CI 1.001-1.003; p < 0.001) and cigarette smoking (OR 2.198, 95% CI 1.109-4.238; p = 0.019) as significant predictors of infection. Synthetic dural graft was not a predictor of infection in multivariate analysis. Infratentorial surgery (OR 4.348, 95% CI 1.234-16.722; p = 0.024) and more than 8 days of postoperative corticosteroid treatment (OR 3.886, 95% CI 1.052-16.607; p = 0.048) were significant predictors for the development of CSF leak. Synthetic dural graft was associated with a lower likelihood of CSF leak (OR 0.072, 95% CI 0.003-0.552; p = 0.036).
  
  
  CONCLUSIONS
  The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Neal
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kahle
authors.forename: Emad N
authors.initials: EN
authors.lastname: Eskandar
authors.forename: Jean-Valery
authors.initials: JV
authors.lastname: Coumans
authors.forename: Brian V
authors.initials: BV
authors.lastname: Nahed
mesh_terms: D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D004388:Dura Mater / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies