Dural Tenting Sutures in Neurosurgery - is it Necessary?

  • STATUS
    Recruiting
  • End date
    Apr 1, 2022
  • participants needed
    2000
  • sponsor
    Medical University of Warsaw
Updated on 23 January 2021

Summary

This study evaluates the necessity of dural tenting sutures in craniotomies. The sutures elevate the dura, a layer between the brain and skull. Supposedly, by doing so, they prevent blood collecting between dura mater and the skull. These blood collections, called epidural hematomas, contributed greatly to postoperative mortality in the early days of neurosurgery. There have been several reports questioning the ongoing need for them in neurosurgery, thanks to modern hemostatic techniques. Moreover, it has been published in the literature, and is a common knowledge as well, that some neurosurgeons do not use these sutures at all, and do not have worse outcomes than their colleagues.

In this study, half of the randomly assigned participants will undergo craniotomy without dural tenting sutures and will be considered an intervention group. The other half will undergo craniotomy with these sutures.

Description

In the early days of neurosurgery, epidural hemorrhages (EDH) contributed to a high mortality rate after craniotomies. Almost a century ago Walter Dandy reported dural tenting sutures as an effective way of preventing postoperative EDH. Over time, his technique gained in popularity and significance to finally become a neurosurgical standard.

Yet, there have been several retrospective reports questioning the ongoing need for dural tenting sutures. Dandy's explanation that the hemostasis under hypotensive conditions is deceiving and eventually causes EDH may be obsolete. These days, proper intra- and postoperative care, including maintenance of normovolemia and normotension and the use of modern hemostatic agents, may be enough for effective hemostasis. Evading of this suturing technique by some surgeons supports this argument even further.

Thus, there is a fundamental need to evaluate the necessity of dural tenting sutures in an unbiased, evidence-based manner.

Details
Condition Epidural hemorrhage, epidural hematoma
Treatment No dural tenting techniques, Dural tenting techniques
Clinical Study IdentifierNCT03658941
SponsorMedical University of Warsaw
Last Modified on23 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

male or female over 18 and under 75 years old
qualified for an elective supratentorial craniotomy with a diameter of at least 3 cm
Glasgow Coma Scale 15 preoperatively
Modified Rankin Scale 0, 1 or 2 preoperatively

Exclusion Criteria

Coagulation abnormalities before the surgery
Revision craniotomy
Skull base surgery
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