title: Autologous dural substitutes: a prospective study.
abstract: OBJECTIVE
  Duraplasty can be performed both by means of autologous tissues (such as galea-pericranium, temporal muscle, fascia lata) or by commercially available dural patches. Nowadays many neurosurgeons consider galea-pericranium duraplasty time-consuming, technically demanding or not adequate, thus dural surrogates are increasingly popular. In this prospective research we compared duraplasty using autologous galea-pericranium vs. dural patches in terms of postoperative long term results, ease/time required and costs.
  
  
  METHODS
  Research has been designed as prospective cohort study, that included 185 patients undergoing supratentorial elective neurosurgery with galea-pericranium or non-autologous duraplasty (minimum follow-up 12 months). Variables taken into account were: wound infection, CSF fistula, subcutaneous CSF collection, bone flap osteitis, brain abscess, empyema and tardive wound dehiscence (particularly after postoperative radiotherapy). Time for galea-pericranium collection, size of galea-pericranium harvest and dural defects were recorded in each case. Costs for non-autologous duroplasty were calculated.
  
  
  RESULTS
  No statistically significant differences were evident in long term postoperative results between the two groups. Mean time of galea-pericranium collection is less than 2min and enough galea-pericranium can be harvested in supratentorial approach to cover almost any dural defect. The only difference between the two groups is costs: an average of 268.7€/patient spent just for duraplasty. This figure is surely substantial if considered for the entire amount of surgeries performed in a department.
  
  
  CONCLUSIONS
  Considering that in our study long term results are equivalent, that galea-pericranium duraplasty is feasible and rapid, our indications are in favor of saving a considerable amount of money since an ideal autologous dural substitute is available and "free".
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sabatino
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy. Electronic address: gdellapepa@hotmail.com.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Della Pepa
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Bianchi
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Capone
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigante
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Albanese
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maira
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Marchese
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016380:Brain Tissue Transplantation / Q000379:methods; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods; D004388:Dura Mater / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014182:Transplantation, Autologous / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Dural graft; Dural substitutes; Duraplasty; Galea; Pericranium