Incidence of complications following non-watertight dural reconstruction with a non-suturable, absorbable collagen matrix onlay graft in elective cranial surgery


  • Asman Ali Department of Neurosurgery, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Debadatta Saha Department of Neurosurgery, Gauhati Medical College and Hospital, Guwahati, Assam, India



CSF leak, Collagen matrix, Dural reconstruction


Background: Collagen matrices are effective duraplasty grafts with increasing acceptability. However, little evidences exits for dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Purpose of our retrospective analysis was to advance our understanding of the use of semisynthetic collagen as dural substitute in elective cranial surgery.

Methods: A consecutive series of sixty patients who underwent elective cranial surgery, where non-watertight dural reconstructions were done with a non-suturable, absorbable collagen matrix onlay graft, has been analysed retrospectively.

Results: Overall, the most common indication for duraplasty was tumor resection (93.3%). CSF leak rate was 10.0%. Incidence of aseptic meningitis was 8.3% and all cases has been resolved with steroids alone. Similarly, postoperative surgical site infection rate was 8.3%. Incidence of pseudomeningocele in follow-up was 6.7%. Only in one case (1.7%), permanent CSF (cerebrospinal fluid) diversion was needed due to troublesome CSF leak with associated hydrocephalus.

Conclusions: Semisynthetic, monolayer collagen matrix used as an onlay dural graft is a simple, yet an attractive alternative in duraplasty due to their easy handling, lower surgical time, and high biocompatibility, where primary dural closure is undesirable or not feasible. Our study provides greater insight into non-water tight duraplasty procedure.  However, further study is needed to determine the optimal strategy for dural reconstruction. Data from this study may be used to compare alternative methods of dural reconstruction in elective cranial surgery. 

Author Biography

Asman Ali, Department of Neurosurgery, Gauhati Medical College and Hospital, Guwahati, Assam, India

Senior Resident

Dept of Neurosurgery

Gauhati Medical College and Hospital


Narotam PK, Qiao F, Nathoo N. Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients. J Neurosurg. 2009;111(2):380-6.

Narotam PK, Reddy K, Fewer D, Qiao F, Nathoo N. Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study. J Neurosurg. 2007;106:45-51.

Barth M, Tuettenberg J, Thomé C, Weiss C, Vajkoczy P, Schmiedek P. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery. 2008;63:352-8.

Preul MC, Bichard WD, Spetzler RF. Toward optimal tissue sealants for neurosurgery: use of a novel hydrogel sealant in a canine durotomy repair model. Neurosurgery. 2003;53:1189-98.

Sade B, Oya S, Lee JH. Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. J Neurosurg. 2011;114(3):714-8.

Knopp U, Christmann F, Reusche E, Sepehrnia A. A new collagen biomatrix of equine origin versus a cadaveric dura graft for the repair of dural defects- a comparative animal experimental study. Acta Neurochir. 2005;147:877-87.

Narotam PK, van Dellen JR, Bhoola KD. A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurg. 1995;82:406-12.

Horaczek JA, Zierski J, Graewe A. Collagen matrix in decompressive hemicraniectomy. Operative Neurosurgery. 2008;63(1):ONS176-81.

Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg. 2001;94:217-23.

Danish SF, Samdani A, Hanna A, Storm P, Sutton L. Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. J Neurosurg. 2006;104(1):16-20.

Grotenhuis JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol. 2005;64:490-3.

Abla AA, Link T, Fusco D, Wilson DA, Sonntag VKH. Comparison of dural grafts in Chiari decompression surgery: review of the literature. J Craniovertebr Junct Spine. 2010;1:29-37.

Osbun JW, Ellenbogen RG, Chesnut RM, Chin LS, Connolly PJ, Cosgrove GR, et al. A multicenter, single-blind, prospective randomized trial to evaluate the safety of a polyethylene glycol hydrogel (duraseal dural sealant system) as a dural sealant in cranial surgery. World Neurosurg. 2012;78:498-504.

Filippi R, Derdilopoulos A, Heimann A, Krummenauer F, Perneczky A, Kempski O. Tightness of duraplasty in rabbits: a comparative study. Neurosurgery. 2000;46:1470-7.

Stendel R, Danne M, Fiss I, Klein I, Schilling A, Hammersen S, et al. Efficacy and safety of a collagen matrix for cranial and spinal dural reconstruction using different fixation techniques. J Neurosurg. 2008;109:215-21.






Original Research Articles