{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:54:52Z","timestamp":1781650492745,"version":"3.54.5"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100019559","name":"Carl von Ossietzky Universit\u00e4t Oldenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019559","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Decompressive hemicraniectomy (DHC) is a treatment option for refractory intracranial pressure (ICP) elevation in cases of cerebral infarction, hemorrhage, and traumatic brain injury. Several surgical techniques are used for musculocutaneous, bony, and dural exposure. The method of dural closure, specifically whether to use expanding duraplasty with or without xenogenic dural substitutes, remains a topic of debate. This study focuses on the occurrence of postoperative surgical side effects associated with these approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 258 patients (mean age 52.8\u2009\u00b1\u200916.7 years; 140 male, 118 female, 79 infarctions, 57 traumatic brain injuries, 55 subarachnoid hemorrhages, 32 intracranial hemorrhages, 30 subdural hematomas, 5 other indications) who underwent DHC between 2015 and 2024 at our institution were reviewed. Complete clinical and radiological data were available for all patients. The patient population was divided into two groups: \u2022 Group A: 201 patients who received the xenogenic dural substitute. \u2022 Group B: 57 patients who did not receive a dural substitute.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline demographics (age, gender, underlying pathology) were comparable between both groups. No significant differences were found in the following parameters: \u2022 Duration of DHC surgery: 102.0\u00a0min (Group A) vs. 108.0\u00a0min (Group B);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.24. \u2022 Postoperative CSF leakage: 3.5% (7\/201) in Group A vs. 3.6% (2\/55) in Group B;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.96. Postoperative shunt dependency: 17.7% (35\/198) in Group A vs. 16.4% (9\/55) in Group B;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.82. \u2022 Postoperative bleeding: 3.5% (7\/198) in Group A vs. 5.5% (3\/55) in Group B;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.52. \u2022 Postoperative wound infections: 7.1% (14\/198) in Group A vs. 1.8% (1\/55) in Group B;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.14. Cranioplasty was performed in 55.8% (110\/197) of the patients in Group A and in 44.4% (24\/54) in Group B. The use of xenogenic dural substitutes did not significantly affect the duration of cranioplasty surgery (114.2\u00a0min vs. 117.6\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.72) or the cranioplasty results. However, the combined wound infection rate for both DHC surgery and cranioplasty showed a trend towards higher wound infection rates in patients who received xenogenic substitutes: \u2022 Combined wound infection rate: 11.6% (23\/198) in Group A vs. 3.5% (2\/57) in Group B;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.07.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of xenogenic substitutes may not significantly impact the prevention of postoperative complication profile with or without the usage of xenogenic dural substitutes in DHC. However, there was a trend towards a higher incidence of postoperative infectious complications in patients who received xenogenic dural substitutes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03185-6","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:40:02Z","timestamp":1776332402000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative complications of xenogenic dural substitutes in hemicraniectomy"],"prefix":"10.1007","volume":"52","author":[{"given":"Levent","family":"Tanrikulu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan Abo","family":"Alhasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"D\u00f6mer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Woitzik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"issue":"Suppl 1","key":"3185_CR1","first-page":"S151","volume":"74","author":"PK Agarwalla","year":"2014","unstructured":"Agarwalla PK, Stapleton CJ, Ogilvy CS. Craniectomy acute ischemic stroke Neurosurg. 2014;74(Suppl 1):S151\u201362.","journal-title":"Craniectomy acute ischemic stroke Neurosurg"},{"key":"3185_CR2","doi-asserted-by":"publisher","unstructured":"Azzam D, Romiyo P, Nguyen T, Sheppard JP, Alkhalid Y, Lagman C, Prashant GN, Yang I. Dural repair in cranial surgery is associated with moderate rates of complications with both autologous and nonautologous dural substitutes. World Neurosurg. 2018;113:244\u2013248. https:\/\/doi.org\/10.1016\/j.wneu.2018.01.115. Epub 2018 Jan 31. PMID: 29374609.","DOI":"10.1016\/j.wneu.2018.01.115"},{"issue":"4","key":"3185_CR3","doi-asserted-by":"publisher","first-page":"954","DOI":"10.3171\/2009.12.JNS091065","volume":"114","author":"E G\u00fcresir","year":"2011","unstructured":"G\u00fcresir E, Vatter H, Schuss P, Oszvald A, Raabe A, Seifert V, Beck J. Rapid closure technique in decompressive craniectomy. J Neurosurg. 2011;114(4):954\u201360. Epub 2010 Jan 29.","journal-title":"J Neurosurg"},{"issue":"5","key":"3185_CR4","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/2013.2.FOCUS1326","volume":"34","author":"SG Heuts","year":"2013","unstructured":"Heuts SG, Bruce SS, Zacharia BE, Hickman ZL, Kellner CP, Sussman ES, et al. Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis. Neurosurg Focus. 2013;34(5):E4.","journal-title":"Neurosurg Focus"},{"issue":"8","key":"3185_CR5","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.02.008","volume":"22","author":"J Inamasu","year":"2013","unstructured":"Inamasu J, Kaito T, Watabe T, Ganaha T, Yamada Y, Tanaka T, et al. Decom-pressive hemicraniectomy for malignant hemispheric stroke in the elderly:comparison of outcomes between individuals 61\u201370 and > 70 years of age. JStroke Cerebrovasc Dis. 2013;22(8):1350\u20134.","journal-title":"JStroke Cerebrovasc Dis"},{"key":"3185_CR6","doi-asserted-by":"crossref","unstructured":"J\u00fcttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, et al. Decompressive surgery for the treatment of malignant infarction ofthe middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38:2518\u201325.","DOI":"10.1161\/STROKEAHA.107.485649"},{"key":"3185_CR7","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/1471-2377-12-115","volume":"12","author":"H Neugebauer","year":"2012","unstructured":"Neugebauer H, Heuschmann PU, Juttler E. Decompressive surgery for thetreatment of malignant infarction of the middle cerebral artery\u2014registry(DESTINY-R): design and protocols. BMC Neurol. 2012;12:115.","journal-title":"BMC Neurol"},{"key":"3185_CR8","doi-asserted-by":"publisher","unstructured":"Nguyen K, Reddy V, Rahimi SY. Dural sandwich technique for hemicraniectomy and benefits during cranioplasty. World Neurosurg. 2019 Apr;124:125\u20138. https:\/\/doi.org\/10.1016\/j.wneu.2018.12.162. Epub 2019 Jan 11.","DOI":"10.1016\/j.wneu.2018.12.162"},{"issue":"2","key":"3185_CR9","doi-asserted-by":"publisher","first-page":"61","DOI":"10.7461\/jcen.2013.15.2.61","volume":"15","author":"J Park","year":"2013","unstructured":"Park J, Hwang JH. Where are we now with decompressive hemicraniectomy for malignant middle cerebral artery infarction? J Cerebrovasc Endovasc Neu-rosurg. 2013;15(2):61\u20136.","journal-title":"J Cerebrovasc Endovasc Neu-rosurg"},{"key":"3185_CR10","doi-asserted-by":"crossref","unstructured":"Rahme R, Curry R, Kleindorfer D, Khoury JC, Ringer AJ, Kissela BM, et al. Howoften are patients with ischemic stroke eligible for decompressive hemicraniec-tomy? Stroke. 2012;43(2):550\u20132.","DOI":"10.1161\/STROKEAHA.111.635185"},{"key":"3185_CR11","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1161\/01.STR.0000257962.58269.e2","volume":"38","author":"CM Schirmer","year":"2007","unstructured":"Schirmer CM, Hoit DA, Malek AM. Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarach-noid hemorrhage. Stroke. 2007;38:987\u201392.","journal-title":"Stroke"},{"key":"3185_CR12","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/2009.4.FOCUS0965","volume":"26","author":"SI Stiver","year":"2009","unstructured":"Stiver SI. Complications of decompressive craniectomy for traumatic braininjury. Neurosurg Focus. 2009;26:E7.","journal-title":"Neurosurg Focus"},{"issue":"6","key":"3185_CR13","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1016\/j.wneu.2014.07.015","volume":"82","author":"K Suyama","year":"2014","unstructured":"Suyama K, Horie N, Hayashi K, Nagata I. Nationwide survey of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Japan. World Neurosurg. 2014;82(6):1158\u201363.","journal-title":"World Neurosurg"},{"key":"3185_CR14","doi-asserted-by":"publisher","first-page":"693","DOI":"10.3171\/jns.2001.94.5.0693","volume":"94","author":"S Wagner","year":"2001","unstructured":"Wagner S, Schnippering H, Aschoff A, Koziol JA, Schwab S, Steiner T. Subop-timum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J Neurosurg. 2001;94:693\u20136.","journal-title":"J Neurosurg"},{"key":"3185_CR15","doi-asserted-by":"publisher","unstructured":"Wright JM, Raghavan A, Wright CH, Alonso A, Momotaz H, Sweet J, Sajatovic M, Selman W. Impact of dual-layer duraplasty during hemicraniectomy on morbidity and operative metrics of cranioplasty: a retrospective case-control study comparing a single-layer with a dual-layer technique. World Neurosurg. 2019 May;125:e1189\u201395. https:\/\/doi.org\/10.1016\/j.wneu.2019.01.276. Epub 2019 Feb 19.","DOI":"10.1016\/j.wneu.2019.01.276"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03185-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03185-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03185-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:11:05Z","timestamp":1781647865000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-026-03185-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3185"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03185-6","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]},"assertion":[{"value":"6 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"132"}}