Trilaminar DuraGen-Anchored Closure for Dural Repair in Posterior Fossa Surgery: Technical Note and Case Series

BACKGROUND AND OBJECTIVES: Cerebrospinal fluid (CSF) leakage remains a common complication of posterior fossa surgery, often exacerbated by early postoperative mobilization. We describe a novel fibrin glue-free technique-trilaminar DuraGen-anchored closure-designed to enhance watertight dural sealing through circumferential suturing of DuraGen patches placed both subdurally and epidurally. METHODS: We retrospectively reviewed 20 patients who underwent posterior fossa surgery with this closure technique between 2020 and 2025. A subdural DuraGen patch approximately 1 cm larger than the dural defect was sutured circumferentially to the native dura. A second DuraGen layer was placed epidurally and similarly sutured. Although fibrin glue was used to seal exposed mastoid air cells, it was deliberately omitted from the duraplasty itself. CSF leak and wound-related complications were assessed clinically, although pseudomeningocele was evaluated radiologically using noncontrast computed tomography on postoperative day 1 and magnetic resonance imaging within 3 months. RESULTS: MRI follow-up was obtained in 18 of 20 patients (90%), with a mean interval of 20.6 months (median: 18.5 months; interquartile range: 16.1 months). The 2 patients without MRI underwent computed tomography and clinical follow-up, with no complications observed. No CSF leaks, pseudomeningoceles, or wound-related complications were identified. No reoperations or lumbar drainage were required. The technique was straightforward and reproducible across levels of surgical experience. CONCLUSION: The trilaminar DuraGen-anchored closure is a simple and effective fibrin glue-free method for achieving watertight dural closure in posterior fossa surgery. Its consistent performance supports further evaluation in broader clinical settings.