Strategy and Standardized Operation Procedure for the Application of Absorbable Dural Sealant Based on the Classification and Grading System of Dural Incision

Background: Durotomy and suturing are very important steps in neurosurgery, as defects in the dura mater can lead to postoperative complications. Different dural incisions and dural defects affect the effectiveness of dural suture, but absorbable dural sealant can aid in watertight suturing of the dura mater. Therefore, we propose a classification and grading system for dural incisions and a standardized operation procedure using absorbable dural sealant to help neurosurgeons improve the effectiveness of dural closure.Methods: According to the type and degree of suture of the dural incision, a classification and grading system of dural incisions was proposed, as well as a standardized operation process for the application of absorbable dural sealant based on the system. Then, we retrospectively analyzed the clinical data (postoperative subcutaneous or epidural drainage volume, rate of subcutaneous effusion formation and rate of antibiotic usage) of patients who were treated with and without absorbable dural sealant. We used these data to verify the effectiveness of absorbable dural sealant in blocking the dura mater and its standardized use.Findings: According to the type of dural incision and the degree of suture of the dural incision, we divided the dural incision into 5 types and 5 grades. Based on the classification and grading system of dural incision, the absorbable dural sealant was applied rationally and in a standardized operation to seal the dural incision tightly. Here, we retrospectively analyzed the clinical data of patients who were treated with and without absorbable dural sealant. The results of the analysis are as follows. In our own group, the subcutaneous or epidural drainage volume of patients who were not treated with dural sealant was significantly higher than that of patients were treated with dural sealant (P<0.001). In our own group, the rate of subcutaneous fluid formation in patients were not treated with dural sealant was 43%, which was higher than that in patients who were treated with dural sealant (19.8%) (P<0.001). In our own group, the rate of antibiotic usage in patients who were not treated with dural sealant was 42.2%, which was higher than that in patients who were treated with dural sealant (20.6%) (P<0.001). The subcutaneous or epidural drainage volume of patients who were treated with dural sealant in our own group was significantly lower than that in other groups (P<0.001). The rate of antibiotic usage in patients who were treated with dural sealant was 20.6% in our own group, which was lower than that in patients who were treated with dural sealant (35.2%) in the other groups (P=0.007).Interpretation: The use of absorbable dural sealant can improve the watertight suturing of the dura mater and reduce the formation of postoperative subcutaneous effusion, postoperative infection and other complications. In addition, the use of absorbable dural sealant should be standardized; otherwise, the effect of the product on closing the dural incision will be reduced. The classification and grading system for dural incisions and our standardized operation procedure for the application of absorbable dural sealant are scientific and rigorous and have great clinical significance and application prospects. We believe that this standard can provide the basis for more clinicians to operate.Funding: This study was funded by Taishan Pandeng Scholar Program of Shandong Province (tspd20210322), Fundamental Research Funds for the Central Universities (2022JC019), Jinan Science and Technology Bureau of Shandong Province (2021GXRC029), Research on the future application prospect of a classical gene marker kit (6010122006), Youth Taishan Scholar Program of Shandong Province(tsqn202211316), Clinical application of POCT diagnosis technology for rapid molecular pathology in brain glioma (National Clinical Practical New Technology Project).Declaration of Interest: None of the authors have conflicts of interest to disclose. None of the authors have financial relationships relevant to this article to disclose.Ethical Approval: This study was approved by the ethics committees of Qilu Hospital of Shandong University. All informed consent forms permitting treatment with implantable consumables have been stored. All patient-relevant information was anonymous and deidentified.