Study of absorbable dural sealant to improve complications after craniocerebral surgery and its application strategy and standardized operation procedure.

Background: Infection after craniocerebral operation has always been a very focused problem, and dural closure can reduce perioperative infection by reducing drainage volume and subcutaneous effusion, so how to effectively perform dural closure seems to be a small but not negligible problem.

Methods: We proposed a classification and grading system for dural incisions based on the type and degree of suture, and based on the system, a standardized operation process for ADS (absorbable dural sealant) was developed. Then, we conducted a retrospective study. We divided the included patients into 3 groups. Normalized group follows the ADS standard use process proposed by us, while Empirical group does not meet or only partially meets the ADS standard use process, or uses ADS based on its own experience, and Non-sealant group were patients who did not use ADS. And perioperative infection was used as the primary assessment metric to verify the effectiveness of ADS in blocking the dural membrane, and to try to propose a standardized use plan.

Results: A retrospective collection of 383 patients' clinical data was conducted between October 2019 and April 2023 in the Department of Neurosurgery of Qilu Hospital of Shandong University. Of them, 128 belonged to the non-sealant group, 126 to the normalized group, and 129 to the empirical group. In our study, we discovered that, in comparison to the normalized group, postoperative cerebral infection rose by 17.2 % (OR = 2.437, P = 0.004) and 21.9 % (OR = 3.227, P < 0.001), respectively, in the empirical group and non-sealant group. In comparison to the normalized group, the empirical group and non-sealant group experienced a 13.2 % (OR = 1.882, P = 0.037) and 24.8 % (OR = 3.346, P < 0.001) increase in subcutaneous effusion development, respectively. Furthermore, when compared to the normalized group, the empirical group's (β = 48.556, P = 0.003) and non-sealant group's (β = 91.960, P < 0.001) subcutaneous or epidural drainage volume was significantly higher.

Conclusions: Correct and standardized use of ADS can improve the watertight suturing of the dura mater and reduce the incidence of postoperative complications such as infection, and is of great significance for perioperative management of neurosurgery.