Is dural hitching necessary to prevent post-operative extradural haemorrhage in craniotomies and craniectomies

Object

The goal of this study was to determine the necessity of dural tenting sutures in preventing post-op extra-dural haematomas (EDH) in craniotomies and craniectomies at a premier Neurosurgical unit in Sri Lanka.

Methods

Data was collected prospectively from 785 cranial operations of patients between the ages of 12 to 75 years. Dural hitching was considered as the control according to current Sri Lankan practices and not performing the dural hitch was considered the intervention. Sample allocation into each group was done alternatively with dura hitching being carried out on the first patient. Data was collected from 403 patients in the control group and 382 patients from the intervention group. The main outcome measure was the indication of significant post- operative EDH with evidence of neurological deficit or a post- operative CT scan with evidence of >30ml collection or midline shift >5mm.

Results

Dural hitching as a prophylactic technique proved no benefit in decreasing the occurrence of post-operative surgically significant extradural collections even in the context of an Asian hospital environment. It however remains as an important neurosurgical technique invaluable in other circumstances.