Dural Tenting Sutures in Neurosurgery - is it Necessary?

NCT ID: NCT03658941

Last Updated: 2024-07-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

490 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-07

Study Completion Date

2022-09-01

Brief Summary

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This study evaluates the necessity of dural tenting sutures in craniotomies. The sutures elevate the dura, a layer between the brain and skull. Supposedly, by doing so, they prevent blood collecting between dura mater and the skull. These blood collections, called epidural hematomas, contributed greatly to postoperative mortality in the early days of neurosurgery. There have been several reports questioning the ongoing need for them in neurosurgery, thanks to modern hemostatic techniques. Moreover, it has been published in the literature, and is a common knowledge as well, that some neurosurgeons do not use these sutures at all, and do not have worse outcomes than their colleagues.

In this study, half of the randomly assigned participants will undergo craniotomy without dural tenting sutures and will be considered an intervention group. The other half will undergo craniotomy with these sutures.

Detailed Description

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In the early days of neurosurgery, epidural hemorrhages (EDH) contributed to a high mortality rate after craniotomies. Almost a century ago Walter Dandy reported dural tenting sutures as an effective way of preventing postoperative EDH. Over time, his technique gained in popularity and significance to finally become a neurosurgical standard.

Yet, there have been several retrospective reports questioning the ongoing need for dural tenting sutures. Dandy's explanation that the hemostasis under hypotensive conditions is deceiving and eventually causes EDH may be obsolete. These days, proper intra- and postoperative care, including maintenance of normovolemia and normotension and the use of modern hemostatic agents, may be enough for effective hemostasis. Evading of this suturing technique by some surgeons supports this argument even further.

Thus, there is a fundamental need to evaluate the necessity of dural tenting sutures in an unbiased, evidence-based manner.

Conditions

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Epidural Hematoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

We plan to include 2000 subjects in this study. Each subject will undergo a craniotomy for unrelated pathology. Each of the subjects will be assigned in random order to an intervention or control group. The intervention group will not have dural tenting sutures during closure of their craniotomy while the control group will have at least three.

Both groups will be followed radiologically and clinically, in the exact same manner.
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Due to the nature of the surgical procedures, the surgeon and the rest of the OR medical team will be aware of the current subject's allocation. However, in each case, the specific OR team aware of the subject's allocation will be different from the investigators performing further evaluation of the given subject. The following study procedures will be in place to ensure double-blind administration of the study.

* Access to the randomization code will be strictly controlled.
* The surgeon will receive information on subject's allocation after commencing the surgery.

The study blind will be broken:

1. During interim monitoring, after recruiting the first 100 patients.
2. On completion of the clinical study and after the study database has been locked.
3. When patients' safety requires access to allocation data.

Study Groups

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No dural tenting sutures

No dural tenting techniques

Group Type EXPERIMENTAL

No dural tenting techniques

Intervention Type PROCEDURE

Not applying dural tenting sutures during closure of a craniotomy

Dural tenting sutures

Dural tenting techniques

Group Type ACTIVE_COMPARATOR

Dural tenting techniques

Intervention Type PROCEDURE

Applying at least 3 dural tenting sutures during closure of a craniotomy

Interventions

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No dural tenting techniques

Not applying dural tenting sutures during closure of a craniotomy

Intervention Type PROCEDURE

Dural tenting techniques

Applying at least 3 dural tenting sutures during closure of a craniotomy

Intervention Type PROCEDURE

Other Intervention Names

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tack-up sutures hitch-up stitches tack-up sutures hitch-up stitches

Eligibility Criteria

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Inclusion Criteria

* male or female over 18 and under 75 years old
* qualified for an elective supratentorial craniotomy with a diameter of at least 3 cm
* Glasgow Coma Scale 15 preoperatively
* Modified Rankin Scale 0, 1 or 2 preoperatively

Exclusion Criteria

* Coagulation abnormalities before the surgery
* Revision craniotomy
* Skull base surgery
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Warsaw

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Łukasz Przepiórka

Role: PRINCIPAL_INVESTIGATOR

Department of Neurosurgery, Medical University of Warsaw

Przemysław Kunert, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Neurosurgery, Medical University of Warsaw

Locations

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Department of Neurosurgery, 10th Military Research Hospital and Polyclinic

Bydgoszcz, Kuyavian-Pomeranian Voivodeship, Poland

Site Status

5 Neurosurgery and Pediatric Neurosurgery Department in Lublin, Medical University of Lublin

Lublin, Lublin Voivodeship, Poland

Site Status

Department of Neurosurgery, Medical University of Warsaw

Warsaw, Mazovian, Poland

Site Status

Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec

Sosnowiec, Silesian Voivodeship, Poland

Site Status

Department of Neurosurgery and Oncology of Central Nervous System, Barlicki University Hospital, Medical University of Lodz

Lodz, Łódź Voivodeship, Poland

Site Status

Countries

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Poland

References

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Swayne OB, Horner BM, Dorward NL. The hitch stitch: an obsolete neurosurgical technique? Br J Neurosurg. 2002 Dec;16(6):541-4; discussion 544.

Reference Type BACKGROUND
PMID: 12617233 (View on PubMed)

Winston KR. Efficacy of dural tenting sutures. J Neurosurg. 1999 Aug;91(2):180-4. doi: 10.3171/jns.1999.91.2.0180.

Reference Type BACKGROUND
PMID: 10433304 (View on PubMed)

Winston KR. Dural tenting sutures in pediatric neurosurgery. Pediatr Neurosurg. 1998 May;28(5):230-5. doi: 10.1159/000028656.

Reference Type BACKGROUND
PMID: 9732254 (View on PubMed)

Wadanamby, S. et al., (2016). Is dural hitching necessary to prevent post-operative extradural haemorrhage in craniotomies and craniectomies. Sri Lanka Journal of Surgery. 34(2), pp.11-17. DOI: http://doi.org/10.4038/sljs.v34i2.8262

Reference Type BACKGROUND

Przepiorka L, Wojtowicz K, Kujawski S, Wisniewski K, Bobeff EJ, Kruk R, Kulesza B, Fortuniak J, Mroz A, Dunaj P, Kaspera M, Hoppe S, Krystkiewicz K, Kwiecien K, Szczepanek D, Jaskolski DJ, Ladzinski P, Rola R, Furtak J, Trojanowski T, Marchel A, Kunert P. Dural Tenting in Elective Craniotomies: A Randomized Clinical Trial. Neurosurgery. 2025 May 1. doi: 10.1227/neu.0000000000003480. Online ahead of print.

Reference Type DERIVED
PMID: 40310111 (View on PubMed)

Kunert P, Przepiorka L, Fortuniak J, Wisniewski K, Bobeff EJ, Larysz P, Kruk R, Kulesza B, Szczepanek D, Ladzinski P, Zylkowski J, Kujawski S, Labedzka K, Jaskolski D, Rola R, Trojanowski T, Marchel A. Prophylactic use of dural tenting sutures in elective craniotomies in adults-is it necessary? A study protocol for a multicentre, investigator- and participant-blinded randomised, parallel-group, non-inferiority trial. Trials. 2021 Apr 12;22(1):273. doi: 10.1186/s13063-021-05201-z.

Reference Type DERIVED
PMID: 33845888 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

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http://rctszwydandy.wum.edu.pl/en

Website of the clinical trial

Other Identifiers

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KB/106/2018

Identifier Type: -

Identifier Source: org_study_id

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