颅脑手术中的硬脑膜修复与自体和非自体硬脑膜替代物的中度并发症发生率相关。
Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes.
作者信息
Azzam Daniel, Romiyo Prasanth, Nguyen Thien, Sheppard John P, Alkhalid Yasmine, Lagman Carlito, Prashant Giyarpuram N, Yang Isaac
机构信息
Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the University of California, Los Angeles, USA.
Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the University of California, Los Angeles, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center of the University of California, Los Angeles, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center of the University of California, Los Angeles, USA; UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center of the University of California, Los Angeles, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA.
出版信息
World Neurosurg. 2018 May;113:244-248. doi: 10.1016/j.wneu.2018.01.115. Epub 2018 Jan 31.
OBJECTIVE
Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery.
METHODS
The PubMed database was systematically searched to identify studies published over the past decade (2007-2017) that described duraplasty procedures. Clinical data were disaggregated and analyzed for the comparisons of biological versus synthetic grafts.
RESULTS
A total of 462 cases were included in the quantitative synthesis. Overall, the most common indication for duraplasty was tumor resection (53%). Allografts were more frequently used in decompression for Chiari malformations compared with xenografts and synthetic grafts (P < 0.001). Xenografts were more frequently used in decompressive hemicraniectomy procedures for evacuation of acute subdural hematomas over allografts and synthetics (P < 0.001). Synthetic grafts were more frequently used in tumor cases than biological grafts (P = 0.002). The cumulative complication rate for dural substitutes of all types was 11%. There were no significant differences in complication rates among the 3 types of dural substitutes.
CONCLUSIONS
Dural substitutes are commonly used to ensure dural closure in a variety of cranial procedures. This study provides greater insight into duraplasty practices and highlights the moderate complication rate associated with the procedure. Future studies are needed to determine the safety and efficacy of such procedures in larger prospective cohorts.
目的
硬脑膜成形术是一种常见的神经外科手术，需要植入合成或生物移植物以确保硬脑膜闭合。本研究的目的是加深我们对颅骨手术中硬脑膜替代物使用的理解。
方法
系统检索PubMed数据库，以识别过去十年（2007 - 2017年）发表的描述硬脑膜成形术的研究。对临床数据进行分类和分析，以比较生物移植物与合成移植物。
结果
定量综合分析共纳入462例病例。总体而言，硬脑膜成形术最常见的适应证是肿瘤切除（53%）。与异种移植物和合成移植物相比，同种异体移植物在Chiari畸形减压术中使用更为频繁（P < 0.001）。在急性硬膜下血肿清除的减压性颅骨切除术过程中，异种移植物比同种异体移植物和合成移植物使用更频繁（P < 0.001）。在肿瘤病例中，合成移植物比生物移植物使用更频繁（P = 0.002）。所有类型硬脑膜替代物的累积并发症发生率为11%。三种类型的硬脑膜替代物在并发症发生率上无显著差异。
结论
硬脑膜替代物常用于各种颅骨手术中确保硬脑膜闭合。本研究为硬脑膜成形术的实践提供了更深入的见解，并突出了该手术相关的中度并发症发生率。未来需要进行研究以确定此类手术在更大规模前瞻性队列中的安全性和有效性。
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