Multilayer dural repair using absorbable artificial dura in the posterior fossa: A case report on the “sandwich technique”

Background: Achieving watertight dural closure in posterior fossa surgery is often challenging due to the anatomical complexity of this region, particularly when suturing is not feasible near critical venous structures. These circumstances increase the risk of cerebrospinal fluid (CSF) leakage, a well-recognized complication. Traditional single-layer techniques may be insufficient to achieve a watertight seal. To address this limitation, we developed a novel multilayer duraplasty method, termed the “Sandwich Technique,” which combines an absorbable collagen matrix with autologous fascia. Methods: A 69-year-old woman with a large tentorial meningioma and obstructive hydrocephalus underwent tumor resection. Intraoperatively, a wide dural defect adjacent to the transverse sinus was identified, where primary closure was not feasible. Reconstruction was performed using the three-layer Sandwich Technique: Step 1, an inlay DuraGen ® sheet placed subdurally and sutured to the tentorium; Step 2, an overlay of autologous fascia lata; and Step 3, an onlay DuraGen ® sheet folded over the fascia and secured with the bone flap. Fibrin glue was applied between each layer to reinforce adhesion. Results: Postoperative imaging confirmed a watertight closure with no evidence of CSF leakage. The patient experienced no complications, and follow-up imaging at 2 months demonstrated a stable reconstruction. Conclusion: The Sandwich Technique provides a simple, reproducible option for dural repair in the posterior fossa when suturing is technically difficult. This multilayer approach, which integrates synthetic and autologous materials, allows tension-free watertight closure and may represent a valuable adjunct in neurosurgical dural reconstruction.