Perrini Paolo
Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
J Neurol Surg B Skull Base. 2015 Mar;76(2):90-3. doi: 10.1055/s-0034-1389370. Epub 2014 Sep 29.
Duraplasty is a step commonly used for the treatment of Chiari I malformation after foramen magnum decompression. A variety of dural substitutes are currently available for dural closure to minimize the complications related to cerebrospinal fluid (CSF). We describe a technique of harvesting occipital pericranium for duraplasty associated with preservation of a wide cuff of muscle at the superior nuchal line that allows anatomical muscle closure at the end of the procedure. Five symptomatic patients with Chiari I malformation and one patient with syringomyelia-Chiari I complex were operated on with this technique. The indications to perform a duraplasty were accidental arachnoid breaching in three patients during an extra-arachnoidal approach and arachnoidal dissection due to intraoperative findings of arachnoid pathology in the remaining three patients. The overall morbidity of this technique was nil. In all patients the postoperative magnetic resonance imaging scan demonstrated significant expansion of the cisterna magna with no evidence of pseudomeningocele. Duraplasty with autologous pericranium and standardized closure of soft tissues seem promising in reducing the CSF-related complications during Chiari surgery.
硬脑膜成形术是枕骨大孔减压术后治疗Chiari I型畸形常用的一个步骤。目前有多种硬脑膜替代物可用于硬脑膜闭合，以尽量减少与脑脊液（CSF）相关的并发症。我们描述了一种获取枕部颅骨膜用于硬脑膜成形术的技术，该技术在枕上线保留宽肌袖，以便在手术结束时进行解剖学上的肌肉闭合。5例有症状的Chiari I型畸形患者和1例脊髓空洞症 - Chiari I型复合体患者接受了该技术手术。进行硬脑膜成形术的指征是：3例患者在蛛网膜外入路期间意外蛛网膜破裂，其余3例患者因术中发现蛛网膜病变而进行蛛网膜剥离。该技术的总体发病率为零。所有患者术后磁共振成像扫描显示枕大池明显扩大，无假性脑膜膨出迹象。自体颅骨膜硬脑膜成形术和软组织的标准化闭合在减少Chiari手术期间与脑脊液相关的并发症方面似乎很有前景。
