Neurosurg Focus 58(2):E7, 2025
• The study focuses on the management of incisional cerebrospinal fluid (CSF) leaks in open cranial surgeries, emphasizing the “folding technique” in duraplasty as an alternative to conventional methods.
• The incidence of iatrogenic incisional CSF leaks was found to be 1.8% among 2149 patients who underwent open cranial surgeries between 2019 and 2024.
• Conservative methods like resuturing and acetazolamide were initially used for CSF leak management, but more invasive procedures like lumbar external drainage (LED), external ventricular drainage (EVD), or surgical reexploration were required when these methods failed.
• The folding technique in duraplasty is highlighted as an effective method for achieving watertight closure, reducing the risk of CSF leakage.
• The study noted that patients who underwent radiotherapy had a longer interval between surgery and leakage onset, suggesting a potential risk factor for delayed CSF leakage.
• Meningitis was a complication in 23.1% of patients with CSF leaks, and the study underscores the importance of maintaining a watertight dura to prevent such complications.
• The study concludes that the folding technique could be a worthy replacement for conventional suturing techniques in dural repair, potentially lowering morbidity associated with CSF leaks.
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