RT info:eu-repo/semantics/doctoralThesis
T1 Análisis de las técnicas de cierre dural en la prevención y el manejo de la fístula de líquido cefalorraquídeo yatrogénica
A1 Sánchez Fernández, Carlos
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Neurocirugía
K1 Dural tear
K1 Defecto dural
K1 Watertight dural closure
K1 Cierre dural hermético
K1 Cerebrospinal fluid leak
K1 Fístula líquido cefalorraquíde
K1 Pseudomeningocele
K1 Pseudomeninocele
K1 32 Ciencias Médicas
AB Processes of dural opening and closure, as well as intraoperative meningeal manipulation, are of particular importance in Neurosurgery. Achieving an optimal dural closure prevents complications related to cerebrospinal fluid leakage, such as fistulas and pseudomeningoceles. These can lead to morbidity for the patient, prolong hospital stays, justify reoperations, and increase healthcare costs.The primary objective of this study is to assess the effectiveness and safety of dural closure through the application of various dural substitution and sealing models in different neurosurgical approaches.An observational case series study is conducted, including patients who underwent surgery at the Neurosurgery Department of the University Clinical Hospital of Valladolid from October 2013 to January 2018. The sample consists of patients who underwent neurosurgical procedures in which a meningeal disruption was identified: either an intentional or incidental dural opening (durotomy). Epidemiological, pathological, procedural variables related to complications arising from dural closure, as well as evolutionary variables, are collected. An initial global data analysis is performed, followed by two subgroup analyses: the first considers the exposure factor "dural closure model: autologous duraplasty versus heterologous or synthetic duraplasty," and the second considers the exposure factor "type of approach used." In both cases, the influence on the outcome "complications related to dural closure" is analyzed.The neuro-surgical history, the dural origin of lesions, the depth of supratentorial procedures, laterality, and the type of cranial opening are factors associated with the use of dural substitutes. Among the determinants for the use of dural substitute is the type of approach (OR= 24.83). Furthermore, the diagnosis motivating the surgery, whether it is a first surgery or reoperation, achieving primary dural closure, the type of dural substitute used, and the coverage of the dural defect are factors related to the use of dural sealants. Diabetes mellitus (OR= 0.006) is the only factor associated with the application of dural sealant. The location of the supratentorial procedure (frontal, temporal, hemispheric, parietal, etc.) is considered the only independent variable related to the occurrence of cerebrospinal fluid fistulas (OR= 0.033). In the case of pseudomeningoceles, no significant association with any variable is found. The application of autologous dural substitutes reduces the risk of surgical bed infection by 23.5% and the risk of reoperation by 14.9% compared to biosynthetic substitutes and allografts. Additionally, both duraplasty models are equally effective in preventing cerebrospinal fluid fistulas and pseudomeningoceles. In open supratentorial cranial surgery, the application of autologous dural substitutes reduces the risk of reoperation by 21.4% compared to biosynthetic substitutes and allografts. Furthermore, both duraplasty models are equally effective in preventing cerebrospinal fluid fistulas and pseudomeningoceles in posterior fossa, spinal, and endoscopic endonasal procedures.There are patient- and procedure-specific factors related to the use of substitutes and sealants in the dural closure process. The location of the procedure (frontal, temporal, parietal, occipital, or hemispheric) in open supratentorial cranial surgeries is the only factor associated with the occurrence of cerebrospinal fluid fistulas. Biosynthetic materials and allografts are useful in the duraplasty process. However, their effectiveness and safety are not superior to the autologous duraplasty model and result in higher healthcare costs. Therefore, personalized evaluation of their indication and use is recommended.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/75494
UL https://uvadoc.uva.es/handle/10324/75494
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 05-abr-2025