Mastering simple interrupted dural closure with Mycro

Preventing Leaks: The Importance of Dural Closure in Neurosurgery

As already explained in our previous article (aggiungere link al precedente blog post sulle suture durali), during cranial and spinal neurosurgery is crucial to ensure a proper seal on the dura mater. If the dura is breached, cerebrospinal fluid (CSF) leakage can occur. This leakage carries significant risks, including fistulas, pseudo-meningocele, and potentially fatal infections like meningitis or cerebritis. These complications can dramatically increase patients’ recovery time, worsen their overall health outcomes, and strain healthcare resources.

Therefore, meticulous closure of the dura is vital for successful surgery. Surgeons employ a variety of suturing techniques and graft materials, with new options continuously being introduced. Ideally, grafts derived from the patient’s own body (autologous grafts) are preferred for their compatibility and lower risk of infection. However, research currently lacks conclusive evidence favoring one specific closure method (autologous vs. non-autologous; continuous vs interrupted suture; microsurgical vs non-microsurgical technique) over another.

This blog post aims to help medical students and residents with the skills needed to master continuous cranial dural closure. It will provide a step-by-step guide using the UpSurgeOn Mycro Training Kit kit, along with highlighting common pitfalls to avoid.

Step-by-step simple interrupted dural closure

1. Preparation

Gather your material:  

  • Needle holder
  • Scissors
  • Forceps
  • Suture material
  • UpSurgeOn Mycro Kit with Brain Pod and Dural Membrane on top of it.
How to setup your Mycro Kit for microsuturing training

2. Placement of Cardinal Sutures

To create cardinal sutures:

  • Hold the needle holder firmly in your dominant hand and secure the needle about two-thirds of its length.
  • Elevate the dura on the opposite side of the planned suture site using forceps in your non-dominant hand to ensure clear visualization.
  • Insert the needle perpendicularly through one dural edge about 0.5 cm away from the edge, following its curvature.
  • Grasp the opposing dural edge with forceps and pass the needle through it at a corresponding point, maintaining the same distance and angle used on the first side.
  • Tie a square knot.
  • Repeat this process for each cardinal suture (north, south, east, and west).

3. Proceed with simple interrupted sutures

As already explained here, starting from the lowest point of the surgical field, work your way upwards proceding with simple interrupted sutures.

Be careful to avoid:

  • Insufficient knot security
  • Irregular suture spacing
  • Excessive suture tension
  • Errors in Needle Placement (see before)

Common mistakes

As already explained in our previous post the most common mistakes are:

  • Needle Choice: Opt for an atraumatic needle, specifically designed to minimize tissue damage, to reduce the risk of dural tears.
  • Needle Positioning: Mount the needle three-fourths of the way from its base to ensure optimal control and maneuverability during suturing.
  • Tension Management: Refrain from excessive pulling on the suture to prevent stretching of the dura and potential leakage.
Example of interrupted microsuture on Mycro Training Kit

Take- Home Messages

Mastering dural closure is crucial in neurosurgery. Here’s a guide to improve dural closure:

  1. Enhance Insight:
    • Understand when to use each technique.
    • Learn to avoid common errors.
  2. Refine Expertise:
    • Practice regularly on Mycro.
  3. Advance Development:
    • Track progress and seek feedback.

By following these steps, you can gain the skills necessary to improve your dural closure, promoting positive patient outcomes and optimal wound healing.

Mastering simple interrupted dural closure with Mycro

Mastering continous dural closure with Mycro

Mastering the Horizontal Mattress Suture

Beyond the Basics: Simple buried suture