Trends in CSF leakage associated with duraplasty in infratentorial procedures over the last twenty years: A Systematic Review

Cerebrospinal fluid (CSF) leakage is a common postoperative complication of neurosurgical procedures, with iatrogenic causes accounting for 16% of CSF leakages. This complication increases healthcare costs and patient morbidity. The focus of this review is to analyze the rates of CSF leakage of some of the most commonly used xenogeneic and synthetic dural substitutes following surgeries in the infratentorial region of the brain where surgical repair can be most challenging. A systematic literature search was conducted using studies detailing duraplasty procedures performed with nonautologous grafts in the infratentorial region in PubMed. Search terms of “posterior fossa” or “infratentorial” were used in combination with “CSF leak,” “CSF leakage,” “cerebrospinal fluid leakage,” “duraplasty” or “dura graft.” The outcome of interest was a measure of the prevalence of CSF leakage rates following posterior fossa neurosurgery. Studies were published between 2006 and 2021. Dural graft materials included bovine collagen, acellular dermis, equine collagen, bovine pericardium, collagen matrix, and ePTFE. The subject number ranged from 6 to 225. CSF leak rates ranged from 0% to 25% with the predominance of studies reporting between 3% and 15%. Bovine collagen, equine collagen, and acellular dermis studies reported higher CSF leakage rates; whereas studies that utilized ePTFE, bovine pericardium, and collagen matrix reported lower CSF leakage rates. Larger prospective controlled studies that evaluate various products in a head-to-head fashion, using the same methods and animal models, are needed to conclude the relative efficacy of thes