Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard University, 110 Francis St, Boston, MA 01125, USA.
Neurosurgery. 2012 Dec;71(2 Suppl Operative):ons302-7. doi: 10.1227/NEU.0b013e31826a8ab0.
Primary closure of the dura in posterior fossa (p-fossa) surgeries is technically difficult and usually requires the use of a dural substitute. A variety of substitutes are currently available and data suggest that autologous materials are preferred in comparison with nonautologous substitutes.
To report our experience using locally harvested autologous pericranium as a dural substitute in patients who underwent p-fossa surgeries.
Retrospective analysis of patients who had undergone p-fossa craniotomies between 2005 and 2011. All patients received locally harvested autologous pericranium for duraplasty augmented with a dural sealant. Data were reviewed for complications including: surgical site infection, meningitis, cerebrospinal fluid leak, the radiographic formation of a pseudomeningocele, and any new neurological symptoms related to the incision or repair.
One hundred patients were identified. Indications for surgery included tumor, vascular lesions, or hemorrhage requiring surgical intervention, symptomatic Chiari I malformation, microvascular decompression for trigeminal neuralgia, and trauma requiring surgical decompression. The complication rate was 1% with 1 patient developing an nonsteroidal anti-inflammatory drug-induced aseptic meningitis and graft dehiscence requiring surgical revision.
Autologous pericranium with dural sealant augmentation is an effective way to repair the durotomy in p-fossa surgeries. To the best of our knowledge, this is currently the largest study using this technique in the adult neurosurgical literature. Our results report a much lower rate of complications in comparison with other duraplasty studies.
在后颅窝（p-窝）手术中，硬脑膜的直接缝合技术难度较大，通常需要使用硬脑膜替代物。目前有多种替代品可供选择，数据表明与非自体替代品相比，自体材料更受青睐。
报告我们在接受 p-窝手术的患者中使用局部采集的自体颅骨膜作为硬脑膜替代物的经验。
回顾性分析 2005 年至 2011 年间接受 p-窝开颅术的患者。所有患者均接受局部采集的自体颅骨膜用于硬脑膜成形术，并使用硬脑膜密封剂进行增强。对包括手术部位感染、脑膜炎、脑脊液漏、假性脑膜膨出的影像学形成以及与切口或修复相关的任何新的神经症状等并发症的数据进行了回顾。
共确定了 100 例患者。手术指征包括肿瘤、血管病变或需要手术干预的出血、症状性 Chiari I 畸形、三叉神经痛微血管减压术和需要手术减压的创伤。并发症发生率为 1%，1 例患者发生非甾体抗炎药诱导的无菌性脑膜炎和移植物裂开，需要手术修复。
自体颅骨膜联合硬脑膜密封剂增强是修复 p-窝手术硬脑膜切开术的有效方法。据我们所知，这是目前成人神经外科学文献中使用该技术的最大研究。我们的结果报告的并发症发生率明显低于其他硬脑膜成形术研究。
