Comparison of Complication between Autograft and Xenograft Duraplasty: A Systematic Review and Meta-Analysis

Background: Cerebrospinal fluid (CSF) leakage is a well-documented and significant complication that can occur following neurosurgical procedures. The association between CSF leakage and various morbidities has been extensively studied. Research on different materials as potential dura mater grafts has been conducted since 1890. The search for the optimal material for dura mater grafts remains ongoing in current research. This investigation aims to assess the incidence of CSF leakage and infection subsequent to duraplasty using xenografts in comparison to autografts. Methods: This study aims to systematically analyze the CSF leakage and infection rates following duraplasty procedures utilizing xenografts and autografts. The research methodology includes a comprehensive search of the PubMed electronic database and a manual search of Google Scholar, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Results: Among the patients in the xenograft group, a total of 90 individuals out of 452 experienced complications in the form of CSF leaks and complicated pseudo-meningoceles. This study was conducted to investigate the incidence of CSF leaks and complicated pseudo-meningoceles in autografts, with a sample size of 540 patients. The results showed that 79 patients experienced these complications, with a statistically significant p-value of 0.05 and an odds ratio of 1.45 (95% confidence interval 1.00-2.10). Another aspect of the study examined the incidence of meningitis complications in xenografts, with a sample size of 400 patients. The results showed that 25 patients experienced meningitis. Among the 446 patients who underwent autografts, 11 patients (p=0.05; OR 2.10, 95% CI 1.01-4.36) experienced meningitis complications. Conclusion: The analysis of duraplasty techniques shows that the use of xenografts increases the incidence of CSF leaks and pseudo-meningocele complications while raising the risk of meningitis.