What question did this study set out to answer?

To evaluate clinical outcomes and complications of decompressive craniectomy with versus without watertight duraplasty in trauma patients.

March 28, 2026

Prospective Randomized Controlled Study Comparing Decompressive Craniectomy with Watertight Duraplasty and without Watertight Duraplasty in Traumatic Brain Injury

Key Points

To evaluate clinical outcomes and complications of decompressive craniectomy with versus without watertight duraplasty in trauma patients.
Conducted a prospective randomized controlled trial with 200 patients aged 15–65.
Patients underwent unilateral decompressive craniectomy for TBI from January 2020 to December 2022.
Participants were randomized into two groups: one with watertight duraplasty and one without.
Intraoperative parameters, complications, and functional outcomes measured using the Glasgow Outcome Scale at 6 months.
Statistical analyses included unpaired t-tests and Fisher exact tests.
Shorter operative time and lower blood loss in the non-watertight group (p < 0.001).
No significant differences in complication rates or mortality between the two groups (p = 0.65).
Mortality was 24% in the watertight group and 28% in the non-watertight group.
Similar functional outcomes at 6 months with no significant difference in GOS scores (p = 0.793).
Cranioplasty-related metrics were also comparable between groups.

Abstract

Abstract Decompressive craniectomy (DC) is a life-saving procedure for refractory intracranial hypertension following traumatic brain injury (TBI). Despite its widespread use, there is no consensus regarding optimal dural management. Whether watertight duraplasty is necessary during DC remains controversial. The aim of the study is to compare clinical outcomes, postoperative complications, and cranioplasty-related outcomes following DC performed with and without watertight duraplasty in patients with TBI. This prospective randomized controlled study included 200 patients (15–65 years) undergoing unilateral DC for TBI between January 2020 and December 2022. Patients were randomized to DC with watertight duraplasty (n = 100) or non-watertight duraplasty (n = 100). Intraoperative parameters, postoperative complications, mortality, and functional outcomes using the Glasgow Outcome Scale (GOS) at 6 months were analyzed. Outcomes following subsequent cranioplasty were also assessed. Statistical analysis included unpaired t-tests and Fisher exact tests. Baseline demographic and clinical characteristics were comparable between groups. The non-watertight duraplasty group demonstrated significantly shorter operative time and lower intraoperative blood loss (p <0.001). Postoperative complication rates, including cerebrospinal fluid leak, wound infection, hydrocephalus, and subdural hygroma, did not differ significantly between groups (p = 0.65). Mortality was 24% in the watertight group and 28% in the non-watertight group. Functional outcomes at 6 months were similar, with no significant difference in GOS scores (p = 0.793). Cranioplasty-related operative metrics and complication rates were also comparable between groups. DC performed with or without watertight duraplasty yields similar postoperative complications, mortality, functional outcomes, and cranioplasty-related results in patients with TBI.

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