Çavuşoğlu, NeslihanErol, GökberkSevgi, Umut TanBulgur, FerideDoğruel, YücelLuzzi, SabinoGadol, Aaron A.CohenGüngor, Abuzer2025-04-182025-04-182024Çavuşoğlu, N., Erol, G., Sevgi, U. T., Bulgur, F., Doğruel, Y., Luzzi, S., ... & Güngor, A. (2024). Graftless Primary Dural Closure Following Retrosigmoid Approach: Doing More With less. World Neurosurgery, 189, e1006-e1012.18788750http://dx.doi.org/10.1016/j.wneu.2024.07.065https://hdl.handle.net/20.500.12713/6415Introduction: Achieving watertight dural closure without grafts via the retrosigmoid approach can be challenging, contributing to a significant rate of postoperative cerebrospinal fluid (CSF) leaks. This study describes a dural incision technique for achieving primary dural closure without grafts following the retrosigmoid approach and presents clinical data from the authors' experience. Methods: Clinical and surgical data of 227 patients who underwent the dural incision technique following the retrosigmoid approach for various pathologies were retrospectively reviewed. To achieve no-graft watertight dural closure, the dural incision involves 2 critical steps: a 1 cm transverse incision of the dura parallel to the foramen magnum to drain CSF from the cisterna magna, and a vertical linear opening of the retrosigmoid dura. Dural incisions were closed watertight with vicryl 4/0 running sutures, without the use of grafts, fibrin glue, hemostatic overlays, or dural substitutes. Pre- or postoperative lumbar drainage was not employed. Results: Primary watertight dural closure was successfully achieved in all patients without the use of grafts or duraplasty. The average duration of dura closure was 17.7 minutes. During an average follow-up period of 49.3 months, there were no instances of CSF leaks or meningitis. Conclusions: In the authors' preliminary experience, the linear dural incision described herein was effective for achieving a no-graft, watertight primary dural closure in the retrosigmoid approach, with no CSF leaks or meningitis in our series. Validation of these preliminary data in a larger patient cohort is necessary. © 2024 Elsevier Inc.eninfo:eu-repo/semantics/closedAccessCSF LeakMeningitisNo-graft TechniqueRetrosigmoid ApproachSurgical OutcomesWatertight ClosureArticle189e1006e101239004178WOS:0013115383000012-s2.0-85200921894Q210.1016/j.wneu.2024.07.065