{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:25:55Z","timestamp":1768217155165,"version":"3.49.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to compare the outcomes of direct suturing (Method 1) and pericranium-assisted suturing (Method 2) for U-shaped dural incisions, with a specific focus on site-specific differences in cerebrospinal fluid (CSF) leak and postoperative infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective cohort, 172 patients undergoing repair of U-shaped dural incisions were analyzed. Based on intraoperative feasibility, patients underwent either Method 1 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200994) or Method 2 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200978). Primary and secondary outcomes were CSF leak and postoperative infection rates, respectively. Subgroup analyses were stratified by surgical site (supratentorial vs. infratentorial).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The incidence of CSF leak was low and comparable between the two methods, regardless of surgical site (Method 1: 7.14% supratentorial vs. 7.69% infratentorial,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20091.00; Method 2: 4.17% vs. 3.33%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20091.00). Re-repair rates were similarly low across all groups. However, Method 2 was associated with a significantly higher overall infection rate in the infratentorial compartment compared to supratentorial surgeries (23.33% vs. 6.25%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039). Sub-analysis revealed this was primarily driven by a higher incidence of incision infection\/delayed healing in the infratentorial group (16.67% vs. 2.08%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028), whereas meningitis rates were comparable. Multivariable analysis confirmed the surgical site itself was not an independent risk factor for infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both direct and pericranium-assisted suturing are effective in preventing CSF leak for U-shaped dural incisions. However, the pericranium-assisted technique carries a significantly increased risk of incision-related infections in the infratentorial region. Clinical decision-making must therefore balance the reliable sealing capability of pericranium-assisted repair against its site-specific infection profile, particularly in complex posterior fossa surgeries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1728951","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:14:09Z","timestamp":1768205649000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative evaluation of two dural closure techniques for U-shaped incisions: sealing efficacy vs. site-specific infection risk"],"prefix":"10.3389","volume":"12","author":[{"given":"Yu","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang-Zhi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai-Long","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Xiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Yin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Long","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi-Hong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e049098","DOI":"10.1136\/bmjopen-2021-049098","article-title":"Single-arm, open-label, multicentre first in human study to evaluate the safety and performance of dural sealant patch in reducing CSF leakage following elective cranial surgery: the ENCASE trial","volume":"11","author":"Van Doormaal","year":"2021","journal-title":"BMJ Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.jocn.2020.07.011","article-title":"Hemopatch\u00ae with fibrin glue as a dural sealant in cranial and spinal surgery. 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