A Comparative Analysis of Early Postoperative Outcomes of Autologous Pericranium versus High-Density Polypropylene in Cranial Duraplasty in a Tertiary Care Centre in Central India

A Comparative Analysis of Early Postoperative Outcomes of Autologous Pericranium versus High-Density Polypropylene in Cranial Duraplasty in a Tertiary Care Centre in Central India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comparative Analysis of Early Postoperative Outcomes of Autologous Pericranium versus High-Density Polypropylene in Cranial Duraplasty in a Tertiary Care Centre in Central India Shubham Gupta, Rakesh Gupta, Zafar Sheikh, kapil Jain, Saksham Kumar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9060777/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objectives Duraplasty is commonly required when primary dural closure is not feasible during cranial surgery. Although both autologous and synthetic dural substitutes are widely used, high-quality prospective data comparing their early postoperative safety remain limited. This study aimed to compare early postoperative complication rates following cranial duraplasty using autologous pericranium versus high-density polypropylene (G-Patch). Methods This prospective comparative study included 100 consecutive patients undergoing cranial duraplasty at a tertiary care center between January and December 2021. Patients were allocated to receive either autologous pericranium (n = 50) or high-density polypropylene (G-Patch) (n = 50) using a standardized surgical technique. Patients were followed for a minimum of 30 days, and early postoperative complications—including cerebrospinal fluid leak, wound infection, and subcutaneous CSF collection—were recorded. Exploratory analyses assessed associations between postoperative complications and selected patient-related factors. Results Traumatic brain injury and intracranial space-occupying lesions were the most common indications for surgery. Most patients in both groups had an uneventful postoperative course. Early postoperative complications occurred more frequently in the synthetic graft group; however, no statistically significant difference was observed between the two graft types (p > 0.05). Wound infection was the most common complication in both cohorts. Exploratory analyses did not demonstrate significant associations between postoperative complications and patient comorbidities or substance use. Conclusion In this prospective cohort, both autologous pericranium and high-density polypropylene demonstrated acceptable short-term safety profiles for cranial duraplasty. Given the heterogeneous indications and focus on early postoperative outcomes, these findings should not be interpreted as evidence of equivalence across specific clinical scenarios. Further studies incorporating stratified analyses, longer follow-up, and functional outcomes are warranted. Dural substitute pericranium G-Patch cranial surgery duraplasty postoperative complications Figures Figure 1 Figure 2 Figure 3 Introduction Achieving satisfactory dural closure after cranial surgery remains a key technical consideration, particularly in the presence of large dural defects, trauma, or dural resection. Inadequate dural repair may be associated with cerebrospinal fluid (CSF) leakage, infection, pseudomeningocele, and prolonged hospitalization( 1 , 2 ). When primary dural closure is not feasible, duraplasty is performed to restore dural integrity and reduce postoperative morbidity( 3 ). A wide range of dural substitutes is currently available, broadly categorized as autologous, xenogeneic/allogeneic, and synthetic materials. Autologous grafts, such as pericranium, are widely regarded as the reference standard because of their excellent biocompatibility, low risk of immunogenic reaction, and favorable integration with the native dura( 3 , 4 ). However, their availability may be limited in patients with prior surgery, scalp trauma, or compromised tissue quality. Synthetic substitutes, including high-density polypropylene (G-Patch), offer immediate availability and consistent material properties, but concerns persist regarding foreign-body reaction, infection risk, and long-term biological integration( 5 ) Traditionally, the ability to achieve a watertight dural closure has been considered an important attribute of an ideal dural substitute, particularly in infratentorial procedures and in cases with elevated CSF pressure( 6 ). However, emerging evidence suggests that strict watertight closure may not be mandatory in selected supratentorial surgeries, where non-watertight closure has been shown to result in acceptable outcomes without increased complication rates( 7 ). This has led to ongoing debate regarding the relative importance of watertight closure versus other graft characteristics, such as biocompatibility and tissue integration, depending on surgical location and context. Despite widespread clinical use of both autologous and synthetic dural substitutes, high-quality prospective comparative data remain limited. Most available studies are retrospective, focus on specific pathologies, or evaluate heterogeneous graft materials, making it difficult to draw definitive conclusions regarding comparative safety and complication profiles. Furthermore, the influence of patient-related factors and surgical variables on postoperative outcomes is inconsistently addressed in the literature. In this context, we conducted a prospective observational comparing autologous pericranium and high-density polypropylene (G-Patch) for cranial duraplasty. The primary objective was to compare early postoperative complication rates between the two graft types. Secondary exploratory analyses examined the association between selected patient-related factors and postoperative outcomes Materials and Methods For the Inclusion Criteria, patients were eligible for the study if they were undergoing cranial neurosurgical procedures requiring dural repair or substitution. Additionally, individuals were included if they presented with dural defects unsuitable for primary closure, thereby necessitating dural substitution. Crucially, all patients were required to provide informed consent for participation in the study prior to enrollment. Regarding the Exclusion Criteria, several factors rendered patients ineligible to participate in the research. These included trauma patients presenting with open, potentially infected wounds, as well as those who were immunocompromised. Patients undergoing a re-exploration procedure were also excluded. Furthermore, individuals with an active systemic infection or a local scalp infection at the surgical site could not be enrolled. Finally, participants with a known allergy or hypersensitivity to synthetic dural substitute materials were excluded from the study. Following the application of these criteria, 100 patients were included in the study. The study was conceived as an exploratory comparison; no a priori sample size or power calculation was performed. The final sample size reflects the number of eligible cases treated during the study period. These patients were randomized into two equal groups of 50. Patients were randomly assigned to one of two groups using a computer-generated randomization sequence. Group A received autologous pericranium, while Group B received G-patch (high-density polypropylene). Allocation concealment was ensured using sealed opaque envelopes, opened only at the time of surgery. This method minimized selection bias and ensured a robust, unbiased comparison of the two graft materials. Surgical cases were categorized as supratentorial or infratentorial based on lesion location; however, the study was not powered to perform stratified comparative analyses between these subgroups. All procedures were performed under general anesthesia by a single experienced neurosurgeon using a standardized operative protocol to minimize technical variability. A scalp incision appropriate to the underlying pathology was made, followed by reflection of the scalp flap with preservation of the pericranium whenever feasible. Hemostasis was achieved using bipolar cautery and bone wax as required. After craniotomy and completion of the primary intracranial procedure, the dura was assessed for the suitability of primary closure. In patients randomized to autologous grafting, a galea-pericranial graft was harvested from the reflected scalp flap, tailored to the size of the dural defect, and kept moist in normal saline until implantation. In patients allocated to synthetic grafting, the high-density polypropylene (G-Patch) was trimmed to the required size and prepared according to the manufacturer’s recommendations. The graft was sutured to the native dura using either interrupted or continuous non-absorbable sutures to achieve a watertight closure(Figs. 1 & 2 ). Additional sutures were placed as necessary to eliminate gaps at the graft–dura interface. The wound was closed in layers, and a sterile dressing was applied. Postoperative daily wound examinations were performed. Patients were monitored for complications, including wound infection, cerebrospinal fluid (CSF) leak, subcutaneous CSF collection, meningitis, empyema, wound dehiscence, and bone flap osteitis. After neurological stabilization, patients were discharged and followed up for a minimum period of 30 days. Patients who did not survive the immediate postoperative period (< 30 days) were excluded from outcome analysis, as postoperative complications could not be reliably assessed. The study had been conducted in accordance with the principles outlined in the Helsinki Declaration as revised in 2024. Informed consent was given by the patients. Ethical clearance for this study was obtained from the Institutional Ethics Committee, vide letter number EC/MGM/NOV-20/129. Statistical analysis: Categorical variables were presented in numbers and percentages (%), and continuous variables were presented as mean ± SD. Quantitative variables were compared using an unpaired t-test between the two groups. Qualitative variables were compared using the Chi-Square test/Fisher’s exact test. A p-value of < 0.05 was considered statistically significant. The data were entered in an MS Excel spreadsheet, and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results A total of 100 patients were included in the study (Table 1), with a male predominance (61%). The most common age group was 30–44 years (27%), followed by 15–29 years (24%) and 45–59 years (25%). Among the 100 patients, 61% were male, and 39% were female. Traumatic brain injury was the most common diagnosis (58%), while brain tumors accounted for 33% of cases. Most of the patients (82%) had no comorbidities; hypertension (7%) and diabetes mellitus (6%) were the most frequent among those with comorbid conditions. Regarding substance use, most patients had no history of substance abuse (67%). Among those who did, alcohol use was the most common (18%), followed by smoking (9%) and tobacco chewing (6%). Dural substitution was equally performed using G-Patch and autologous pericranium in 50% of patients each. Table 1 : Demographic and Clinical Profile of Patients (N = 100) Sociodemographic and clinical parameters G-patch Pericranium Total Age Group (years) 0-14 1 9 10 15-29 14 10 24 30-44 17 10 27 45-59 11 14 25 60-74 7 7 14 Gender Male 30 31 61 Female 20 19 39 Diagnosis Head Injury 40 18 58 Tumour 8 25 33 Miscellaneous 0 5 5 Non-Traumatic Bleed 2 2 4 Substance Abuse Nil 28 39 67 Alcohol 12 6 18 Smoking 6 3 9 Tobacco 4 2 6 Co morbidities Nil 43 39 82 Hypertension 4 3 7 DM 1 5 6 Asthma 1 1 2 CAD 1 0 1 CKD 0 1 1 Hepatitis B 0 1 1 Table 2 shows the distribution of postoperative complications according to the type of dural substitute used in our study: high-density polypropylene versus pericranium. The majority of patients in both groups experienced no complications (74.0% in the polypropylene group and 88.0% in the pericranium group). Wound infection was the most common complication, occurring in 16.0% of patients with high-density polypropylene and 8.0% with pericranium. Other complications, such as subcutaneous cerebrospinal fluid (CSF) collection, CSF leak, empyema, meningitis, bone flap osteitis, and wound dehiscence, were observed at low frequencies across both groups. Statistical analysis was performed using Fisher’s Exact Test. No statistically significant difference was observed between the two groups for any postoperative complication (all p-values > 0.05). Table 2 : Distribution of postoperative complications by type of dural substitute used Complication High-Density Polypropylene (n=50) Pericranium (n=50) Nil (No complications) 37 44 Wound infection 8 4 Subcutaneous CSF collection 4 0 CSF leak 2 1 Empyema 1 2 Meningitis 1 0 Bone flap osteitis 1 0 Wound dehiscence 0 2 Figure 3 shows that the Pericranium group had a higher rate of uneventful recovery (88%) compared to the high-density polypropylene group (74%). Statistical analysis using Fisher’s Exact Test showed no significant difference between the two dural substitutes for any of the complications (all p-values > 0.05). Table 3 summarizes the distribution of postoperative complications according to various patient comorbidities, including asthma, coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM), hepatitis B, and hypertension. The majority of patients without complications had no documented comorbidities (79.0%), while smaller proportions had individual comorbidities. Wound infection occurred predominantly in patients without comorbidities (91.7%), with only a single case observed in a hypertensive patient. Other complications, such as subcutaneous cerebrospinal fluid (CSF) collection, CSF leak, empyema, wound dehiscence, meningitis, and bone flap osteitis, were exclusively observed in patients without any recorded comorbidities. Association between postoperative complications and comorbidities was evaluated using Pearson’s chi-square test (χ² = 5.348, degrees of freedom = 42, p = 1.00), showing no statistically significant association. The high p-value suggests that the occurrence of complications was independent of the comorbidity status. Table 3 Distribution of postoperative complications to comorbidities: Complications Asthma CAD CKD DM Hepatitis B Hypertension No Comorbidity Total Nil (No complications) 2 1 1 6 1 6 64 81 Wound infection 0 0 0 0 0 1 11 12 Subcutaneous CSF collection 0 0 0 0 0 0 4 4 CSF Leak 0 0 0 0 0 0 3 3 Empyema 0 0 0 0 0 0 3 3 Wound dehiscence 0 0 0 0 0 0 2 2 Meningitis 0 0 0 0 0 0 1 1 Bone flap osteitis 0 0 0 0 0 0 1 1 The distribution of postoperative complications was also examined in relation to substance abuse, including alcohol use, smoking, and tobacco chewing, as detailed in Table 4 . Most patients without complications did not have a history of substance abuse (65.4%), while smaller proportions reported alcohol (18.5%), smoking (11.1%), or tobacco use (4.9%). Wound infections and other complications occurred primarily in patients without substance abuse, although isolated cases were observed among alcohol and tobacco users. Pearson’s chi-square test was performed to assess the association between substance abuse and postoperative complications. The test produced a chi-square value of 17.309 with 21 degrees of freedom and a p-value of 0.692, indicating no statistically significant association between substance abuse status and the occurrence of postoperative complications. Table 4 Postoperative complications related to substance abuse: Complications Alcohol Smoking Tobacco No Substance Abuse Total Nil (No complications) 15 9 4 53 81 Wound infection 2 0 1 9 12 Subcutaneous CSF collection 0 0 1 3 4 CSF Leak 0 0 1 2 3 Empyema 0 0 0 3 3 Wound dehiscence 0 0 0 2 2 Meningitis 0 0 0 1 1 Bone flap osteitis 1 0 0 0 1 Discussion Duraplasty involves repairing dural defects by applying either autologous (natural) or synthetic (non-autologous) grafts to restore dural integrity. The first reported use of dural substitutes dates back to 1895, by Robert Abbe( 3 , 8 ), and since then, various materials have been utilized for dural reconstruction. An ideal dural substitute should provide a watertight seal, closely mimic the natural dura mater’s mechanical properties, be cost-effective, easy to handle when wet, minimize inflammation and scarring, and promote neodura formation( 3 , 8 , 9 ). Over the past five decades, autologous grafts such as pericranium, fascia lata, and temporalis fascia have been widely used( 8 ). These grafts are inexpensive, non-immunogenic, and integrate well with native dura but may be limited by availability and require an additional surgical site for harvest. Cadaveric dura, first described by Campbell et al.( 10 ), offers abundant graft material but carries risks such as transmission of Creutzfeldt-Jakob disease or bovine spongiform encephalopathy, limiting its use. Synthetic dural substitutes, made from polymers like high-density polypropylene, provide an inert alternative with good strength, elasticity, and malleability. However, they may provoke foreign body reactions, inflammation, and lack of vascularization or epithelial fusion seen with autologous grafts( 11 , 12 ) The choice of a dural substitute depends on factors such as defect size, surgical approach, availability, and cost. The use of different dural substitutes depends on the indications for duraplasty. In a recent article, it was determined that the most common indication for duraplasty was tumor resection (53% cases), which was covered using synthetic grafts( 8 ). In Contrast, around 60% of duraplasty cases in our cohort were decompressive craniectomies for traumatic brain injury, with excision of space-occupying lesions being the second most common indication. The duration to harvest pericranium was minimal and did not affect operative time compared to the immediately available synthetic graft. Both grafts provided sufficient material to close large dural defects effectively. Although watertight dural closure has traditionally been emphasized, especially in posterior fossa surgery, evidence suggests that in selected supratentorial procedures, a non-watertight closure may be acceptable( 7 , 13 ). In our practice, we aimed for watertight closure in all cases to standardize technique and minimize confounding, particularly given the heterogeneous cohort. A study by Sabatino et al.( 14 ), demonstrated that during supratentorial craniotomies, adequate autologous grafts could be easily harvested to cover any dural defect, regardless of size. Although G-Patch is typically more expensive than biological grafts, its availability through institutional support ensured that no additional financial burden was transferred to the patients, making it a more economical choice from the hospital’s perspective. As far as the complication rates are concerned, the comparison of autologous and synthetic grafts shows increased complications, such as infections and CSF leak, with synthetic grafts. In a study by Malliti et al.( 15 ), the use of neuropatch (synthetic Substitute) was associated with increased deep wound infection (15% vs. 5%, p = 0.06) and CSF leaks (13% vs.1.6%, p < 0.05). The reason was ascribed to the foreign material's reaction to the implanted dural synthetic substitute. However, the difference in complication rate between group A and B was not statistically significant. Wound infection was the most frequent complication, followed by CSF leak and subcutaneous CSF collection. Less common complications included wound dehiscence, bone flap osteitis, empyema, and meningitis. These results align with previous studies, which generally report no significant differences in complication rates between autologous and synthetic dural substitutes, though some have noted a trend favouring autologous grafts( 4 , 5 , 8 , 16 ) Unlike prior studies( 5 ) that focused on a single pathology, such as traumatic brain injury, the present study included patients undergoing cranial duraplasty for diverse indications. However, this heterogeneity was accompanied by an imbalance in underlying diagnoses between the two graft groups, with traumatic brain injury predominating in the G-Patch group and tumor-related procedures more frequent in the pericranium group. As etiology, defect characteristics, contamination risk, and adjuvant therapies are known to influence postoperative complication rates, this imbalance introduces potential confounding by indication. Consequently, pooled comparisons should be interpreted with caution, and the results cannot be extrapolated to suggest equivalence of grafts across specific diagnostic categories. Similar to our study, Abla AA et al( 4 ), in their literature review, did not support the superiority of either autologous or nonautologous grafts when duraplasty is employed in Chiari decompression surgery. Cost considerations are important when selecting dural substitutes, particularly in tertiary care and resource-constrained settings( 14 ). Autologous pericranium avoids material costs but may be unavailable in some cases, whereas synthetic grafts, such as high-density polypropylene, offer immediate availability at a higher material cost. Although this study was not designed to evaluate cost-effectiveness, the comparable short-term safety profiles observed suggest that graft choice may reasonably be influenced by institutional resources and logistical considerations. While the duration of hospital stay may reflect duraplasty success, it is influenced by multiple factors, including the patient’s neurological status and systemic complications such as respiratory infections( 17 , 18 ). Regarding patient factors, no significant association was found between substance abuse (alcohol, smoking, tobacco) or comorbidities and the incidence of postoperative complications. Limitations This study has several important limitations. Although the prospective design strengthens data collection, the sample size was modest and not powered to permit stratified or multivariable-adjusted analyses. There was an imbalance in underlying surgical indications between groups, with traumatic brain injury more common in the synthetic graft group and tumor-related procedures more frequent in the pericranium group, introducing potential confounding by indication. Although supratentorial and infratentorial duraplasty differ in anatomical and surgical considerations, the present study was not powered to evaluate location-specific outcomes, which limits inference regarding graft performance across these compartments. The analysis was limited to early postoperative complications, and no intraoperative variables, neurological recovery, functional status, or patient-reported quality-of-life outcomes were assessed. As these outcomes are integral to the comprehensive evaluation of dural substitute performance, their absence restricts the conclusions to short-term safety only. Longer follow-up and larger studies incorporating indication-specific and functional outcome measures are required to more fully define the comparative effectiveness of dural substitutes. CONCLUSION This prospective study evaluated the short-term safety of autologous pericranium and high-density polypropylene (G-Patch) used for cranial duraplasty in a heterogeneous cohort. No statistically significant difference was observed in early postoperative complication rates between the two graft types in the overall analysis, although a higher number of complications occurred in the synthetic graft group. Given the absence of stratified analyses, the imbalance in underlying indications between groups, and the focus on early postoperative outcomes alone, these findings should not be interpreted as evidence of equivalence across specific clinical scenarios such as trauma, tumor, or hemorrhage. Rather, the results indicate that both grafts demonstrated acceptable short-term safety within the scope of the studied population. Situations in which autologous pericranium is unavailable or unsuitable were not specifically evaluated, and graft selection in such cases remains guided by clinical judgment. Further studies incorporating indication-specific analyses and functional outcome measures are required to better define graft performance across different surgical settings. Abbreviations CSF Cerebrospinal fluid DM Diabetes Mellitus CAD Coronary Artery Disease CKD Chronic Kidney Disease Declarations Disclosures: The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Acknowledgements: None Conflict of Interest: Nil Funding The authors report no involvement in the research by the sponsor that could have influenced the outcome of this work Conflict of Interest The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Shubham Gupta, Saksham Kumar, Rakesh Gupta, Zafar Sheikh, and Kapil Jain. The first draft of the manuscript was written by Shubham Gupta, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript Ethics approval Ethical clearance for this study was obtained from the Institutional Ethics Committee, vide letter number EC/MGM/NOV-20/129 Consent to participate Informed consent was obtained from all individual participants included in the study. Consent to publish The authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 1 and 2. Clinical trial number: not applicable. References Dong RP, Zhang Q, Yang LL, Cheng XL, Zhao JW. Clinical management of dural defects: A review. World J Clin Cases. 2023;11(13):2903–15. doi: 10.12998/wjcc.v11.i13.2903 Palermo M, Zeoli F, Rastegar V, Sturiale CL, Signorelli F. Risk Factors for Postoperative Cerebrospinal Fluid Fistulas After Craniotomy and Craniectomy: A Systematic Review and Meta-Analysis. Acta Neurochir (Wien). 2025;167(1):264. doi: 10.1007/s00701-025-06685-3 Masang Ban Bolly H, Faried A, Laurens Jembise T, Fuad Wirakusumah F, Zafrullah Arifin M. The ideal selection criteria for duraplasty material in brain surgery: A review. Interdisciplinary Neurosurgery. 2020;22:100800. doi: 10.1016/j.inat.2020.100800 Abla A, Link T, Fusco D, Wilson D, Sonntag VKH. Comparison of dural grafts in Chiari decompression surgery: Review of the literature. J Craniovertebr Junction Spine. 2010;1(1):29. doi: 10.4103/0974-8237.65479 Pandit VA, Sharma RK, Bhaskar S, Kindra AS, Choudhary A, Gupta L. A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury Patients. Indian Journal of Neurotrauma. 2021;18(01):26–31. doi: 10.1055/s-0040-1717216 Splavski B, Frol S. Selecting Substitutes for Cranial Dural Repair and Preventing Intracranial Iatrogenic Amyloid Transmission. Cureus. 2025;17(6):e86487. doi: 10.7759/cureus.86487 PubMed PMID: 40693052. Gibbon FL, Lindner RJ, Silva MT, Gago G, Chaddad-Neto F. The Role of Watertight Dural Closure in Supratentorial Craniotomy: A Systematic Review and Meta-Analysis. Operative Neurosurgery. 2025;28(2):141–7. doi: 10.1227/ons.0000000000001301 Azzam D, Romiyo P, Nguyen T, Sheppard JP, Alkhalid Y, Lagman C, et al. Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes. World Neurosurg. 2018;113:244–8. doi: 10.1016/j.wneu.2018.01.115 Khurana D, Suresh A, Nayak R, Shetty M, Sarda RK, Knowles JC, et al. Biosubstitutes for dural closure: Unveiling research, application, and future prospects of dura mater alternatives. J Tissue Eng. 2024;15:20417314241228120. doi:10.1177/20417314241228118 PubMed PMID: 38343772. Campbell JB, Bassett CAL, Robertson JW. Clinical Use of Freeze-Dried Human Dura Mater. J Neurosurg. 1958;15(2):207–14. doi: 10.3171/jns.1958.15.2.0207 Maulana AF, Nurikhwan PW, Lahdimawan A, Ahsani IF, Lahdimawan MRR, Jamila A. Reducing complications in duraplasty with autologous dural graft material: A meta-analysis. J Cerebrovasc Endovasc Neurosurg. 2025;27(2):103–17. doi: 10.7461/jcen.2025.E2023.12.004 Sapkota S, Karn M. Extradural abscess following synthetic fabric duraplasty. Surg Neurol Int. 2021;12:234. doi: 10.25259/SNI_310_2021 Hirbo Guyolla Y, Biluts Mersha H, Tesfaye Abebe F. Predictors of cerebrospinal fluid leakage after elective cranial surgery. Interdisciplinary Neurosurgery. 2023;31:101704. doi: 10.1016/j.inat.2022.101704 Sabatino G, Della Pepa GM, Bianchi F, Capone G, Rigante L, Albanese A, et al. Autologous dural substitutes: A prospective study. Clin Neurol Neurosurg. 2014;116:20–3. doi: 10.1016/j.clineuro.2013.11.010 Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX. Comparison of Deep Wound Infection Rates Using a Synthetic Dural Substitute (Neuro-Patch) or Pericranium Graft for Dural Closure: A Clinical Review of 1 Year. Neurosurgery. 2004;54(3):599–604. doi: 10.1227/01.NEU.0000108640.45371.1A Ramola M, Ramola M, Singh J, Khurana L, Chhabra S, Garg R, et al. Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study. Oper Neurosurg (Hagerstown). 2025;28(3):357–67. doi: 10.1227/ons.0000000000001306 PubMed PMID: 39132991. Elsamadicy AA, Koo AB, Lee M, David WB, Kundishora AJ, Freedman IG, et al. Risk Factors Portending Extended Length of Stay After Suboccipital Decompression for Adult Chiari I Malformation. World Neurosurg. 2020;138:e515–22. doi: 10.1016/j.wneu.2020.02.158 PubMed PMID: 32147550. Dasenbrock HH, Liu KX, Devine CA, Chavakula V, Smith TR, Gormley WB, et al. Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Neurosurg Focus. 2015;39(6):E12. doi: 10.3171/2015.10.FOCUS15386 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9060777","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608493513,"identity":"3a5e2b56-44e0-4189-9a91-ac67730d2395","order_by":0,"name":"Shubham Gupta","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYBACNvn2Z9K8Pw7L8c9IbP7MwGAnZ3CAgBZ+iTNm0rw9h40l7jw+cJiBIdnYkpAWyRk5bNK8bYcTN8g/SwBqOZi4n5AWgxsgLT2H0zdI5xgAtRxI3EZYS/rz37w//ueSoiUB7JfcjbeJ1WIP1tJ2ON3gRv4HsJYNxNnSdjgB6CkDsPeJ0HLGTHJmz2HDGWAtBsnGBOPF4H77M4mPPw7L88/IMf78o4KIqEQ3gTTlo2AUjIJRMApwAACeaFgVW9oIEAAAAABJRU5ErkJggg==","orcid":"","institution":"Sawai ManSingh Medical College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Shubham","middleName":"","lastName":"Gupta","suffix":""},{"id":608493514,"identity":"9bf9927b-3722-4d0e-b476-802a1387ad01","order_by":1,"name":"Rakesh Gupta","email":"","orcid":"","institution":"Mahatma Gandhi Memorial Medical College","correspondingAuthor":false,"prefix":"","firstName":"Rakesh","middleName":"","lastName":"Gupta","suffix":""},{"id":608493515,"identity":"7d482cfd-a9e8-4bbc-8de8-84d8905bdbcf","order_by":2,"name":"Zafar Sheikh","email":"","orcid":"","institution":"Mahatma Gandhi Memorial Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zafar","middleName":"","lastName":"Sheikh","suffix":""},{"id":608493516,"identity":"e0b6114d-1fac-44e6-8015-a390d4da2b31","order_by":3,"name":"kapil Jain","email":"","orcid":"","institution":"Max Super Speciality Hospital","correspondingAuthor":false,"prefix":"","firstName":"kapil","middleName":"","lastName":"Jain","suffix":""},{"id":608493517,"identity":"0649913c-b8e9-4cd1-bf10-971d7283656a","order_by":4,"name":"Saksham Kumar","email":"","orcid":"","institution":"Mahatma Gandhi Memorial Medical College","correspondingAuthor":false,"prefix":"","firstName":"Saksham","middleName":"","lastName":"Kumar","suffix":""}],"badges":[],"createdAt":"2026-03-07 20:53:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9060777/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9060777/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105563399,"identity":"f994dff2-ab44-48de-a8cf-cc2e37c41b35","added_by":"auto","created_at":"2026-03-27 12:46:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1003644,"visible":true,"origin":"","legend":"\u003cp\u003eAugmentation duraplasty with Pericranium in Space Occupying Lesion excision\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9060777/v1/94133108fa777b687a846b4c.png"},{"id":105150017,"identity":"c54d6609-c967-4775-9b8b-cc5676ef41c9","added_by":"auto","created_at":"2026-03-22 14:59:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":779388,"visible":true,"origin":"","legend":"\u003cp\u003eLax duraplasty using high-density Polypropylene dural patch (G-Patch) in Decompressive Craniectomy\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9060777/v1/d5b2b8799826818fba513db5.png"},{"id":105150019,"identity":"731be807-f336-417d-b105-c1bfa6bd6f27","added_by":"auto","created_at":"2026-03-22 14:59:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":147272,"visible":true,"origin":"","legend":"\u003cp\u003ePost op Complication Comparison between autologous and high-density polypropylene dural substitute\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9060777/v1/4bc99e8083b9caf4f5ef96ea.png"},{"id":105569233,"identity":"807af9db-fd4a-4a66-a8f9-5d03fe844ffc","added_by":"auto","created_at":"2026-03-27 13:11:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3733499,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9060777/v1/3910caa6-4402-4cef-a640-5dd967a50688.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Comparative Analysis of Early Postoperative Outcomes of Autologous Pericranium versus High-Density Polypropylene in Cranial Duraplasty in a Tertiary Care Centre in Central India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAchieving satisfactory dural closure after cranial surgery remains a key technical consideration, particularly in the presence of large dural defects, trauma, or dural resection. Inadequate dural repair may be associated with cerebrospinal fluid (CSF) leakage, infection, pseudomeningocele, and prolonged hospitalization(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). When primary dural closure is not feasible, duraplasty is performed to restore dural integrity and reduce postoperative morbidity(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA wide range of dural substitutes is currently available, broadly categorized as autologous, xenogeneic/allogeneic, and synthetic materials. Autologous grafts, such as pericranium, are widely regarded as the reference standard because of their excellent biocompatibility, low risk of immunogenic reaction, and favorable integration with the native dura(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, their availability may be limited in patients with prior surgery, scalp trauma, or compromised tissue quality. Synthetic substitutes, including high-density polypropylene (G-Patch), offer immediate availability and consistent material properties, but concerns persist regarding foreign-body reaction, infection risk, and long-term biological integration(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eTraditionally, the ability to achieve a watertight dural closure has been considered an important attribute of an ideal dural substitute, particularly in infratentorial procedures and in cases with elevated CSF pressure(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, emerging evidence suggests that strict watertight closure may not be mandatory in selected supratentorial surgeries, where non-watertight closure has been shown to result in acceptable outcomes without increased complication rates(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This has led to ongoing debate regarding the relative importance of watertight closure versus other graft characteristics, such as biocompatibility and tissue integration, depending on surgical location and context.\u003c/p\u003e \u003cp\u003eDespite widespread clinical use of both autologous and synthetic dural substitutes, high-quality prospective comparative data remain limited. Most available studies are retrospective, focus on specific pathologies, or evaluate heterogeneous graft materials, making it difficult to draw definitive conclusions regarding comparative safety and complication profiles. Furthermore, the influence of patient-related factors and surgical variables on postoperative outcomes is inconsistently addressed in the literature.\u003c/p\u003e \u003cp\u003eIn this context, we conducted a prospective observational comparing autologous pericranium and high-density polypropylene (G-Patch) for cranial duraplasty. The primary objective was to compare early postoperative complication rates between the two graft types. Secondary exploratory analyses examined the association between selected patient-related factors and postoperative outcomes\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eFor the Inclusion Criteria, patients were eligible for the study if they were undergoing cranial neurosurgical procedures requiring dural repair or substitution. Additionally, individuals were included if they presented with dural defects unsuitable for primary closure, thereby necessitating dural substitution. Crucially, all patients were required to provide informed consent for participation in the study prior to enrollment.\u003c/p\u003e \u003cp\u003eRegarding the Exclusion Criteria, several factors rendered patients ineligible to participate in the research. These included trauma patients presenting with open, potentially infected wounds, as well as those who were immunocompromised. Patients undergoing a re-exploration procedure were also excluded. Furthermore, individuals with an active systemic infection or a local scalp infection at the surgical site could not be enrolled. Finally, participants with a known allergy or hypersensitivity to synthetic dural substitute materials were excluded from the study.\u003c/p\u003e \u003cp\u003eFollowing the application of these criteria, 100 patients were included in the study.\u003c/p\u003e \u003cp\u003eThe study was conceived as an exploratory comparison; no a priori sample size or power calculation was performed. The final sample size reflects the number of eligible cases treated during the study period. These patients were randomized into two equal groups of 50. Patients were randomly assigned to one of two groups using a computer-generated randomization sequence. Group A received autologous pericranium, while Group B received G-patch (high-density polypropylene). Allocation concealment was ensured using sealed opaque envelopes, opened only at the time of surgery. This method minimized selection bias and ensured a robust, unbiased comparison of the two graft materials. Surgical cases were categorized as supratentorial or infratentorial based on lesion location; however, the study was not powered to perform stratified comparative analyses between these subgroups.\u003c/p\u003e \u003cp\u003eAll procedures were performed under general anesthesia by a single experienced neurosurgeon using a standardized operative protocol to minimize technical variability.\u003c/p\u003e \u003cp\u003eA scalp incision appropriate to the underlying pathology was made, followed by reflection of the scalp flap with preservation of the pericranium whenever feasible. Hemostasis was achieved using bipolar cautery and bone wax as required. After craniotomy and completion of the primary intracranial procedure, the dura was assessed for the suitability of primary closure.\u003c/p\u003e \u003cp\u003eIn patients randomized to autologous grafting, a galea-pericranial graft was harvested from the reflected scalp flap, tailored to the size of the dural defect, and kept moist in normal saline until implantation. In patients allocated to synthetic grafting, the high-density polypropylene (G-Patch) was trimmed to the required size and prepared according to the manufacturer\u0026rsquo;s recommendations. The graft was sutured to the native dura using either interrupted or continuous non-absorbable sutures to achieve a watertight closure(Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additional sutures were placed as necessary to eliminate gaps at the graft\u0026ndash;dura interface. The wound was closed in layers, and a sterile dressing was applied.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePostoperative daily wound examinations were performed. Patients were monitored for complications, including wound infection, cerebrospinal fluid (CSF) leak, subcutaneous CSF collection, meningitis, empyema, wound dehiscence, and bone flap osteitis. After neurological stabilization, patients were discharged and followed up for a minimum period of 30 days. Patients who did not survive the immediate postoperative period (\u0026lt;\u0026thinsp;30 days) were excluded from outcome analysis, as postoperative complications could not be reliably assessed.\u003c/p\u003e \u003cp\u003e The study had been conducted in accordance with the principles outlined in the Helsinki Declaration as revised in 2024. Informed consent was given by the patients. Ethical clearance for this study was obtained from the Institutional Ethics Committee, vide letter number EC/MGM/NOV-20/129.\u003c/p\u003e \u003cp\u003e Statistical analysis: Categorical variables were presented in numbers and percentages (%), and continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Quantitative variables were compared using an unpaired t-test between the two groups. Qualitative variables were compared using the Chi-Square test/Fisher\u0026rsquo;s exact test. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. The data were entered in an MS Excel spreadsheet, and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 100 patients were included in the study (Table 1), with a male predominance (61%). The most common age group was 30\u0026ndash;44 years (27%), followed by 15\u0026ndash;29 years (24%) and 45\u0026ndash;59 years (25%). Among the 100 patients, 61% were male, and 39% were female. Traumatic brain injury was the most common diagnosis (58%), while brain tumors accounted for 33% of cases. Most of the patients (82%) had no comorbidities; hypertension (7%) and diabetes mellitus (6%) were the most frequent among those with comorbid conditions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding substance use, most patients had no history of substance abuse (67%). Among those who did, alcohol use was the most common (18%), followed by smoking (9%) and tobacco chewing (6%). Dural substitution was equally performed using G-Patch and autologous pericranium in 50% of patients each.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Demographic and Clinical Profile of Patients (N = 100)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"554\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eSociodemographic and clinical parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003eG-patch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003ePericranium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eAge Group (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0794%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9278%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003e0-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003e15-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003e30-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003e45-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003e60-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0794%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9278%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003e\u0026nbsp;Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9278%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eHead Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eTumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eMiscellaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eNon-Traumatic Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eSubstance Abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eTobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eCo morbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eCAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eCKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58.8448%;\"\u003e\n \u003cp\u003eHepatitis B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.0794%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.9278%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the distribution of postoperative complications according to the type of dural substitute used in our study: high-density polypropylene versus pericranium. The majority of patients in both groups experienced no complications (74.0% in the polypropylene group and 88.0% in the pericranium group). Wound infection was the most common complication, occurring in 16.0% of patients with high-density polypropylene and 8.0% with pericranium. Other complications, such as subcutaneous cerebrospinal fluid (CSF) collection, CSF leak, empyema, meningitis, bone flap osteitis, and wound dehiscence, were observed at low frequencies across both groups. Statistical analysis was performed using Fisher\u0026rsquo;s Exact Test. No statistically significant difference was observed between the two groups for any postoperative complication (all p-values \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: Distribution of postoperative complications by type of dural substitute used\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"538\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003eHigh-Density Polypropylene (n=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003ePericranium (n=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eNil (No complications)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eWound infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eSubcutaneous CSF collection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eCSF leak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eEmpyema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eMeningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eBone flap osteitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6617%;\"\u003e\n \u003cp\u003eWound dehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2268%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.1115%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the Pericranium group had a higher rate of uneventful recovery (88%) compared to the high-density polypropylene group (74%). Statistical analysis using Fisher\u0026rsquo;s Exact Test showed no significant difference between the two dural substitutes for any of the complications (all p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the distribution of postoperative complications according to various patient comorbidities, including asthma, coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM), hepatitis B, and hypertension. The majority of patients without complications had no documented comorbidities (79.0%), while smaller proportions had individual comorbidities. Wound infection occurred predominantly in patients without comorbidities (91.7%), with only a single case observed in a hypertensive patient. Other complications, such as subcutaneous cerebrospinal fluid (CSF) collection, CSF leak, empyema, wound dehiscence, meningitis, and bone flap osteitis, were exclusively observed in patients without any recorded comorbidities. Association between postoperative complications and comorbidities was evaluated using Pearson\u0026rsquo;s chi-square test (χ\u0026sup2; = 5.348, degrees of freedom\u0026thinsp;=\u0026thinsp;42, p\u0026thinsp;=\u0026thinsp;1.00), showing no statistically significant association. The high p-value suggests that the occurrence of complications was independent of the comorbidity status.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of postoperative complications to comorbidities:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCAD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHepatitis B\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo Comorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNil (No complications)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubcutaneous CSF collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCSF Leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone flap osteitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe distribution of postoperative complications was also examined in relation to substance abuse, including alcohol use, smoking, and tobacco chewing, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Most patients without complications did not have a history of substance abuse (65.4%), while smaller proportions reported alcohol (18.5%), smoking (11.1%), or tobacco use (4.9%). Wound infections and other complications occurred primarily in patients without substance abuse, although isolated cases were observed among alcohol and tobacco users. Pearson\u0026rsquo;s chi-square test was performed to assess the association between substance abuse and postoperative complications. The test produced a chi-square value of 17.309 with 21 degrees of freedom and a p-value of 0.692, indicating no statistically significant association between substance abuse status and the occurrence of postoperative complications.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative complications related to substance abuse:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTobacco\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo Substance Abuse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNil (No complications)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubcutaneous CSF collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCSF Leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone flap osteitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDuraplasty involves repairing dural defects by applying either autologous (natural) or synthetic (non-autologous) grafts to restore dural integrity. The first reported use of dural substitutes dates back to 1895, by Robert Abbe(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), and since then, various materials have been utilized for dural reconstruction.\u003c/p\u003e \u003cp\u003eAn ideal dural substitute should provide a watertight seal, closely mimic the natural dura mater\u0026rsquo;s mechanical properties, be cost-effective, easy to handle when wet, minimize inflammation and scarring, and promote neodura formation(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Over the past five decades, autologous grafts such as pericranium, fascia lata, and temporalis fascia have been widely used(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These grafts are inexpensive, non-immunogenic, and integrate well with native dura but may be limited by availability and require an additional surgical site for harvest.\u003c/p\u003e \u003cp\u003eCadaveric dura, first described by Campbell et al.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), offers abundant graft material but carries risks such as transmission of Creutzfeldt-Jakob disease or bovine spongiform encephalopathy, limiting its use. Synthetic dural substitutes, made from polymers like high-density polypropylene, provide an inert alternative with good strength, elasticity, and malleability. However, they may provoke foreign body reactions, inflammation, and lack of vascularization or epithelial fusion seen with autologous grafts(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe choice of a dural substitute depends on factors such as defect size, surgical approach, availability, and cost. The use of different dural substitutes depends on the indications for duraplasty. In a recent article, it was determined that the most common indication for duraplasty was tumor resection (53% cases), which was covered using synthetic grafts(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In Contrast, around 60% of duraplasty cases in our cohort were decompressive craniectomies for traumatic brain injury, with excision of space-occupying lesions being the second most common indication.\u003c/p\u003e \u003cp\u003eThe duration to harvest pericranium was minimal and did not affect operative time compared to the immediately available synthetic graft. Both grafts provided sufficient material to close large dural defects effectively. Although watertight dural closure has traditionally been emphasized, especially in posterior fossa surgery, evidence suggests that in selected supratentorial procedures, a non-watertight closure may be acceptable(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In our practice, we aimed for watertight closure in all cases to standardize technique and minimize confounding, particularly given the heterogeneous cohort. A study by Sabatino et al.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), demonstrated that during supratentorial craniotomies, adequate autologous grafts could be easily harvested to cover any dural defect, regardless of size. Although G-Patch is typically more expensive than biological grafts, its availability through institutional support ensured that no additional financial burden was transferred to the patients, making it a more economical choice from the hospital\u0026rsquo;s perspective.\u003c/p\u003e \u003cp\u003eAs far as the complication rates are concerned, the comparison of autologous and synthetic grafts shows increased complications, such as infections and CSF leak, with synthetic grafts. In a study by Malliti et al.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), the use of neuropatch (synthetic Substitute) was associated with increased deep wound infection (15% vs. 5%, p\u0026thinsp;=\u0026thinsp;0.06) and CSF leaks (13% vs.1.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The reason was ascribed to the foreign material's reaction to the implanted dural synthetic substitute. However, the difference in complication rate between group A and B was not statistically significant. Wound infection was the most frequent complication, followed by CSF leak and subcutaneous CSF collection. Less common complications included wound dehiscence, bone flap osteitis, empyema, and meningitis. These results align with previous studies, which generally report no significant differences in complication rates between autologous and synthetic dural substitutes, though some have noted a trend favouring autologous grafts(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eUnlike prior studies(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) that focused on a single pathology, such as traumatic brain injury, the present study included patients undergoing cranial duraplasty for diverse indications. However, this heterogeneity was accompanied by an imbalance in underlying diagnoses between the two graft groups, with traumatic brain injury predominating in the G-Patch group and tumor-related procedures more frequent in the pericranium group. As etiology, defect characteristics, contamination risk, and adjuvant therapies are known to influence postoperative complication rates, this imbalance introduces potential confounding by indication. Consequently, pooled comparisons should be interpreted with caution, and the results cannot be extrapolated to suggest equivalence of grafts across specific diagnostic categories. Similar to our study, Abla AA et al(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), in their literature review, did not support the superiority of either autologous or nonautologous grafts when duraplasty is employed in Chiari decompression surgery.\u003c/p\u003e \u003cp\u003eCost considerations are important when selecting dural substitutes, particularly in tertiary care and resource-constrained settings(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Autologous pericranium avoids material costs but may be unavailable in some cases, whereas synthetic grafts, such as high-density polypropylene, offer immediate availability at a higher material cost. Although this study was not designed to evaluate cost-effectiveness, the comparable short-term safety profiles observed suggest that graft choice may reasonably be influenced by institutional resources and logistical considerations. While the duration of hospital stay may reflect duraplasty success, it is influenced by multiple factors, including the patient\u0026rsquo;s neurological status and systemic complications such as respiratory infections(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Regarding patient factors, no significant association was found between substance abuse (alcohol, smoking, tobacco) or comorbidities and the incidence of postoperative complications.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThis study has several important limitations. Although the prospective design strengthens data collection, the sample size was modest and not powered to permit stratified or multivariable-adjusted analyses. There was an imbalance in underlying surgical indications between groups, with traumatic brain injury more common in the synthetic graft group and tumor-related procedures more frequent in the pericranium group, introducing potential confounding by indication. Although supratentorial and infratentorial duraplasty differ in anatomical and surgical considerations, the present study was not powered to evaluate location-specific outcomes, which limits inference regarding graft performance across these compartments.\u003c/p\u003e \u003cp\u003eThe analysis was limited to early postoperative complications, and no intraoperative variables, neurological recovery, functional status, or patient-reported quality-of-life outcomes were assessed. As these outcomes are integral to the comprehensive evaluation of dural substitute performance, their absence restricts the conclusions to short-term safety only.\u003c/p\u003e \u003cp\u003eLonger follow-up and larger studies incorporating indication-specific and functional outcome measures are required to more fully define the comparative effectiveness of dural substitutes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis prospective study evaluated the short-term safety of autologous pericranium and high-density polypropylene (G-Patch) used for cranial duraplasty in a heterogeneous cohort. No statistically significant difference was observed in early postoperative complication rates between the two graft types in the overall analysis, although a higher number of complications occurred in the synthetic graft group. Given the absence of stratified analyses, the imbalance in underlying indications between groups, and the focus on early postoperative outcomes alone, these findings should not be interpreted as evidence of equivalence across specific clinical scenarios such as trauma, tumor, or hemorrhage.\u003c/p\u003e \u003cp\u003eRather, the results indicate that both grafts demonstrated acceptable short-term safety within the scope of the studied population. Situations in which autologous pericranium is unavailable or unsuitable were not specifically evaluated, and graft selection in such cases remains guided by clinical judgment. Further studies incorporating indication-specific analyses and functional outcome measures are required to better define graft performance across different surgical settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCerebrospinal fluid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronary Artery Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Kidney Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003eDisclosures:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: None\u003c/p\u003e\n\u003cp\u003eConflict of Interest: Nil\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors report no involvement in the research by the sponsor that could have influenced the outcome of this work\u003c/p\u003e\n\u003cp\u003eConflict of Interest\u003c/p\u003e\n\u003cp\u003eThe authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Shubham Gupta, Saksham Kumar, Rakesh Gupta, Zafar Sheikh, and Kapil Jain. The first draft of the manuscript was written by Shubham Gupta, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eEthical clearance for this study was obtained from the Institutional Ethics Committee, vide letter number EC/MGM/NOV-20/129\u003c/p\u003e\n\u003cp\u003eConsent to participate\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eConsent to publish\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 1 and 2.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDong RP, Zhang Q, Yang LL, Cheng XL, Zhao JW. Clinical management of dural defects: A review. World J Clin Cases. 2023;11(13):2903\u0026ndash;15. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12998/wjcc.v11.i13.2903\u003c/span\u003e\u003cspan address=\"10.12998/wjcc.v11.i13.2903\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalermo M, Zeoli F, Rastegar V, Sturiale CL, Signorelli F. Risk Factors for Postoperative Cerebrospinal Fluid Fistulas After Craniotomy and Craniectomy: A Systematic Review and Meta-Analysis. Acta Neurochir (Wien). 2025;167(1):264. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00701-025-06685-3\u003c/span\u003e\u003cspan address=\"10.1007/s00701-025-06685-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasang Ban Bolly H, Faried A, Laurens Jembise T, Fuad Wirakusumah F, Zafrullah Arifin M. The ideal selection criteria for duraplasty material in brain surgery: A review. Interdisciplinary Neurosurgery. 2020;22:100800. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.inat.2020.100800\u003c/span\u003e\u003cspan address=\"10.1016/j.inat.2020.100800\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbla A, Link T, Fusco D, Wilson D, Sonntag VKH. Comparison of dural grafts in Chiari decompression surgery: Review of the literature. J Craniovertebr Junction Spine. 2010;1(1):29. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0974-8237.65479\u003c/span\u003e\u003cspan address=\"10.4103/0974-8237.65479\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePandit VA, Sharma RK, Bhaskar S, Kindra AS, Choudhary A, Gupta L. A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury Patients. Indian Journal of Neurotrauma. 2021;18(01):26\u0026ndash;31. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0040-1717216\u003c/span\u003e\u003cspan address=\"10.1055/s-0040-1717216\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSplavski B, Frol S. Selecting Substitutes for Cranial Dural Repair and Preventing Intracranial Iatrogenic Amyloid Transmission. Cureus. 2025;17(6):e86487. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.86487\u003c/span\u003e\u003cspan address=\"10.7759/cureus.86487\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PubMed PMID: 40693052.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibbon FL, Lindner RJ, Silva MT, Gago G, Chaddad-Neto F. The Role of Watertight Dural Closure in Supratentorial Craniotomy: A Systematic Review and Meta-Analysis. Operative Neurosurgery. 2025;28(2):141\u0026ndash;7. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1227/ons.0000000000001301\u003c/span\u003e\u003cspan address=\"10.1227/ons.0000000000001301\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzzam D, Romiyo P, Nguyen T, Sheppard JP, Alkhalid Y, Lagman C, et al. Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes. World Neurosurg. 2018;113:244\u0026ndash;8. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.wneu.2018.01.115\u003c/span\u003e\u003cspan address=\"10.1016/j.wneu.2018.01.115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhurana D, Suresh A, Nayak R, Shetty M, Sarda RK, Knowles JC, et al. Biosubstitutes for dural closure: Unveiling research, application, and future prospects of dura mater alternatives. J Tissue Eng. 2024;15:20417314241228120. doi:10.1177/20417314241228118 PubMed PMID: 38343772.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell JB, Bassett CAL, Robertson JW. Clinical Use of Freeze-Dried Human Dura Mater. J Neurosurg. 1958;15(2):207\u0026ndash;14. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/jns.1958.15.2.0207\u003c/span\u003e\u003cspan address=\"10.3171/jns.1958.15.2.0207\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaulana AF, Nurikhwan PW, Lahdimawan A, Ahsani IF, Lahdimawan MRR, Jamila A. Reducing complications in duraplasty with autologous dural graft material: A meta-analysis. J Cerebrovasc Endovasc Neurosurg. 2025;27(2):103\u0026ndash;17. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7461/jcen.2025.E2023.12.004\u003c/span\u003e\u003cspan address=\"10.7461/jcen.2025.E2023.12.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSapkota S, Karn M. Extradural abscess following synthetic fabric duraplasty. Surg Neurol Int. 2021;12:234. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.25259/SNI_310_2021\u003c/span\u003e\u003cspan address=\"10.25259/SNI_310_2021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirbo Guyolla Y, Biluts Mersha H, Tesfaye Abebe F. Predictors of cerebrospinal fluid leakage after elective cranial surgery. Interdisciplinary Neurosurgery. 2023;31:101704. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.inat.2022.101704\u003c/span\u003e\u003cspan address=\"10.1016/j.inat.2022.101704\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSabatino G, Della Pepa GM, Bianchi F, Capone G, Rigante L, Albanese A, et al. Autologous dural substitutes: A prospective study. Clin Neurol Neurosurg. 2014;116:20\u0026ndash;3. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clineuro.2013.11.010\u003c/span\u003e\u003cspan address=\"10.1016/j.clineuro.2013.11.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX. Comparison of Deep Wound Infection Rates Using a Synthetic Dural Substitute (Neuro-Patch) or Pericranium Graft for Dural Closure: A Clinical Review of 1 Year. Neurosurgery. 2004;54(3):599\u0026ndash;604. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1227/01.NEU.0000108640.45371.1A\u003c/span\u003e\u003cspan address=\"10.1227/01.NEU.0000108640.45371.1A\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamola M, Ramola M, Singh J, Khurana L, Chhabra S, Garg R, et al. Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study. Oper Neurosurg (Hagerstown). 2025;28(3):357\u0026ndash;67. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1227/ons.0000000000001306\u003c/span\u003e\u003cspan address=\"10.1227/ons.0000000000001306\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PubMed PMID: 39132991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElsamadicy AA, Koo AB, Lee M, David WB, Kundishora AJ, Freedman IG, et al. Risk Factors Portending Extended Length of Stay After Suboccipital Decompression for Adult Chiari I Malformation. World Neurosurg. 2020;138:e515\u0026ndash;22. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.wneu.2020.02.158\u003c/span\u003e\u003cspan address=\"10.1016/j.wneu.2020.02.158\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PubMed PMID: 32147550.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDasenbrock HH, Liu KX, Devine CA, Chavakula V, Smith TR, Gormley WB, et al. Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Neurosurg Focus. 2015;39(6):E12. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/2015.10.FOCUS15386\u003c/span\u003e\u003cspan address=\"10.3171/2015.10.FOCUS15386\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dural substitute, pericranium, G-Patch, cranial surgery, duraplasty, postoperative complications","lastPublishedDoi":"10.21203/rs.3.rs-9060777/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9060777/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuraplasty is commonly required when primary dural closure is not feasible during cranial surgery. Although both autologous and synthetic dural substitutes are widely used, high-quality prospective data comparing their early postoperative safety remain limited. This study aimed to compare early postoperative complication rates following cranial duraplasty using autologous pericranium versus high-density polypropylene (G-Patch).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective comparative study included 100 consecutive patients undergoing cranial duraplasty at a tertiary care center between January and December 2021. Patients were allocated to receive either autologous pericranium (n = 50) or high-density polypropylene (G-Patch) (n = 50) using a standardized surgical technique. Patients were followed for a minimum of 30 days, and early postoperative complications—including cerebrospinal fluid leak, wound infection, and subcutaneous CSF collection—were recorded. Exploratory analyses assessed associations between postoperative complications and selected patient-related factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraumatic brain injury and intracranial space-occupying lesions were the most common indications for surgery. Most patients in both groups had an uneventful postoperative course. Early postoperative complications occurred more frequently in the synthetic graft group; however, no statistically significant difference was observed between the two graft types (p \u0026gt; 0.05). Wound infection was the most common complication in both cohorts. Exploratory analyses did not demonstrate significant associations between postoperative complications and patient comorbidities or substance use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this prospective cohort, both autologous pericranium and high-density polypropylene demonstrated acceptable short-term safety profiles for cranial duraplasty. Given the heterogeneous indications and focus on early postoperative outcomes, these findings should not be interpreted as evidence of equivalence across specific clinical scenarios. Further studies incorporating stratified analyses, longer follow-up, and functional outcomes are warranted.\u003c/p\u003e","manuscriptTitle":"A Comparative Analysis of Early Postoperative Outcomes of Autologous Pericranium versus High-Density Polypropylene in Cranial Duraplasty in a Tertiary Care Centre in Central India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-22 14:59:46","doi":"10.21203/rs.3.rs-9060777/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d4ef1ef-22d5-40fe-b7a2-e51927dfd560","owner":[],"postedDate":"March 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T08:08:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-22 14:59:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9060777","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9060777","identity":"rs-9060777","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}