A National Survey of Duramater Closure Techniques in Indonesia: Surgeon Preferences, Risk Factors and Cost Constraints in Neurosurgical Practice

This study surveyed duraplasty practices among Indonesian neurosurgeons, focusing on material selection, clinical considerations, complications, and healthcare financing. An online questionnaire was distributed to 170 alumni of the Bandung Neurosurgery Training Center between February and August 2025, with an overall 50% response rate. Eighty-five responses were analyzed descriptively and compared with international practices. The results show that major CSF leak risk factors include increased intracranial pressure, re-operations, and incidental durotomy, with prevention strategies emphasizing watertight closure, non-absorbable silk sutures, and dural sealants. Cost and patient indication were the main determinants in technique selection. Indonesian neurosurgeons generally prefer autologous grafts for cost-effectiveness. The study highlights the need for standardized, evidence-based guidelines and further comparative research to ensure efficient and sustainable neurosurgical care under national health insurance.