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A watertight duraplasty is performed using an AlloDerm patch (asterisk) with a running 5-0 Prolene suture following a standard Y-shaped dural opening. Subsequently, a Duragen onlay and Tisseal are applied to reinforce this dural closure (not shown). This duraplasty pulsates with the cardiac and respiratory cycles as shown in our included operative videos, synchronizing the flow of CSF between cranial and spinal compartments.
