COMPARATIVE ANALYSIS OF DUROPLASTY TECHNIQUES IN DECOMPRESSIVE CRANIECTOMY FOR TRAUMATIC BRAIN INJURY
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Keywords
TB I, G PATCH, Re Dura
Abstract
Background and Objective
At present, there is no consensus regarding the most optimal dural substitute to use for duroplasty in primary decompressive craniectomy for traumatic brain injury (TBI). The author's objective was to conduct a retrospective analysis comparing 2 techniques of duroplasty: duroplasty using Regenerative Dural Repair Patch -ReDura (RD group) with G patch (GP group). G patch is designed to repair defects in soft tissues & re-enforcement of soft tissues such as Durameter , Peritoneal pleura etc. The patch is made of Poly Propylene (same as Prolene Mesh). G-Patch-2 is made of High Density Polyethylene. Each Pack contains one patch.
Methods
From July 2022 to September 2024, 120 craniotomies were done for TBI. Out of these, 20 received vascularized galea pericranium and 100 received synthetic dural graft for dural augmentation either Redura or G-Patch. For analysis, 30 frome ach group (RD/GP) were taken. The primary outcome was extended Glasgow Outcome Scale (GOS-E) measured at 3 months after injury. Secondary outcomes included were incidence of surgical complications (neurosurgical site infections, and hemorrhagic and hydrodynamic complications), surgical time, days in intensive care unit, hospital length of stay, hospital mortality.
Results
The primary outcome GOS-E at 3 months was worse in the GP group than in the RD group. Post- op complications were evaluated as shown in Table below. The frequencies of haematoma and brain abscess were recorded. Out of 60 patients who underwent PDC, 7 got hematoma and 2 got brain abscess.
Conclusion
In this retrospective study, adults who underwent DUROPLASTY for TBI using ReDura were associated with significantly lower rates of postoperative hematoma (p = 0.0105) compared to those using G-Patch. However, no statistically significant difference was found in brain abscess rates (p = 0.4915) or GOS-E functional outcomes (p = 0.5506) at 3 months. Further prospective, larger-scale studies are recommended to confirm these findings.
References
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Dr. Zothansanga Zadeng
Senior Resident, Department of Neurosurgery, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.
Dr. Rahul Jain
Senior Resident, Department of Neurosurgery, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.
Dr. Rajesh R Raykar
Professor, Department of Neurosurgery, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.
Dr. Shailesh A.V. Rao
Professor, Department of Neurosurgery, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.