Lee Christine K, Mokhtari Tara, Connolly Ian D, Li Gordon, Shuer Lawrence M, Chang Steven D, Steinberg Gary K, Hayden Gephart Melanie
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
World Neurosurg. 2017 Dec;108:33-40. doi: 10.1016/j.wneu.2017.08.061. Epub 2017 Aug 31.
Posterior fossa decompression surgeries for Chiari malformations are susceptible to postoperative complications such as pseudomeningocele, external cerebrospinal fluid (CSF) leak, and meningitis. Various dural substitutes have been used to improve surgical outcomes.
This study examined whether the collagen matrix dural substitute type correlated with the incidence of postoperative complications after posterior fossa decompression in adult patients with Chiari I malformations.
A retrospective cohort study was conducted of 81 adult patients who underwent an elective decompressive surgery for treatment of symptomatic Chiari I malformations, with duraplasty involving a dural substitute derived from either bovine or porcine collagen matrix. Demographics and treatment characteristics were correlated with surgical outcomes.
A total of 81 patients were included in the study. Compared with bovine dural substitute, porcine dural substitute was associated with a significantly higher risk of pseudomeningocele occurrence (odds ratio, 5.78; 95% confidence interval, 1.65-27.15; P = 0.01) and a higher overall complication rate (odds ratio, 3.70; 95% confidence interval, 1.23-12.71; P = 0.03) by univariate analysis. There was no significant difference in the rate of meningitis, repeat operations, or overall complication rate between the 2 dural substitutes. In addition, estimated blood loss was a significant risk factor for meningitis (P = 0.03). Multivariate analyses again showed that porcine dural substitute was associated with pseudomeningocele occurrence, although the association with higher overall complication rate did not reach significance.
Dural substitutes generated from porcine collagen, compared with those from bovine collagen, were associated with a higher likelihood of pseudomeningocele development in adult patients undergoing Chiari I malformation decompression and duraplasty.
Chiari畸形的后颅窝减压手术易发生术后并发症，如假性脑脊膜膨出、脑脊液外漏和脑膜炎。各种硬脑膜替代物已被用于改善手术效果。
本研究探讨在成年Chiari I型畸形患者后颅窝减压术后，胶原基质硬脑膜替代物类型是否与术后并发症发生率相关。
对81例因有症状的Chiari I型畸形接受择期减压手术并行硬脑膜成形术的成年患者进行回顾性队列研究，硬脑膜成形术采用牛或猪胶原基质来源的硬脑膜替代物。将人口统计学和治疗特征与手术结果相关联。
本研究共纳入81例患者。单因素分析显示，与牛硬脑膜替代物相比，猪硬脑膜替代物发生假性脑脊膜膨出的风险显著更高（比值比，5.78；95%置信区间，1.65 - 27.15；P = 0.01），总体并发症发生率也更高（比值比，3.70；95%置信区间，1.23 - 12.71；P = 0.03）。两种硬脑膜替代物在脑膜炎发生率、再次手术率或总体并发症发生率方面无显著差异。此外，估计失血量是脑膜炎的一个显著危险因素（P = 0.03）。多因素分析再次显示，猪硬脑膜替代物与假性脑脊膜膨出的发生相关，尽管与总体并发症发生率较高的关联未达到显著水平。
在接受Chiari I型畸形减压和硬脑膜成形术的成年患者中，与牛胶原来源的硬脑膜替代物相比，猪胶原来源的硬脑膜替代物发生假性脑脊膜膨出的可能性更高。
