Watertight Dural Closure in Pediatric Craniotomies—Is It Really Necessary?

Background: Dural closure after intracranial procedures is considered crucial to reduce postoperative complications such as pseudomeningocele (PM), cerebrospinal fluid (CSF) leaks, hydrocephalus, and infections. However, watertight dural closure (WTDC) is often difficult to achieve, and dural substitutes often are used. We describe our experience with non-WTDC in children. Methods: Data were collected retrospectively. Redo and craniectomy cases were excluded. Collected data included demographics, surgical etiology, various radiologic parameters, ventricular opening, usage of drains and shunts, dural closure technique, and complications. Results: In total, 163 cases aged 3 months to 18.5 years (90 ± 56 months) were included. Main surgical indications were tumors (120, 74%) and epilepsy (29, 18%). In total, 122 (74%) cases were supratentorial. The ventricular system was opened in 69 (42%) cases. In 145 (89%) cases, a non-WTDC was performed. Fibrin glue was used in 22 (13%) cases. In 156 cases (96%), a dural substitute was used. One patient (0.6%) had a CSF leak. At 3 months, 20% had a radiologic PM but only 8.4% were noticed clinically. At 1 year, 7.7% had a radiologic PM but only 3% were noticed clinically. Overall, 3% needed a PM tap, and 15 patients (9%) underwent CSF diversion procedures. There were no infections. The only factor significantly associated with PM or a need for CSF surgery was an infratentorial location. Conclusions: Non-WTDC after cranial surgery in children was associated with a low rate of clinically significant PM, infections, leaks, and hydrocephalus. Non-WTDC is fast and reduces the need to harvest additional tissue, thus minimizing the surgical incision.