Dlouhy Brian J, Menezes Arnold H
1Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital; and.
3Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa.
J Neurosurg Pediatr. 2018 Sep;22(3):297-305. doi: 10.3171/2018.3.PEDS17550. Epub 2018 Jun 22.
OBJECT Techniques for combined extradural and intradural decompression with expansile duraplasty for Chiari malformation type I (CM-I) have been well described, with various allogenic and autologous materials used for duraplasty. However, the approach and surgical technique used for duraplasty in our treatment of CM-I and developed by the senior author in the 1990s has not been described. METHODS A prospective database was initiated in March 2003 to denote the use of cervical fascia for duraplasty and incorporate an ongoing detailed record of complications during the surgical treatment of children and adults with CM-I with and without syringomyelia. A total of 389 surgeries for CM-I were performed on 379 patients from March 2003 to June 2016. A total of 123 posterior procedures were performed on 123 patients in which both a posterior fossa extradural and intradural decompression with duraplasty (extra-intradural) was performed. In this paper the authors describe the surgical technique for harvesting and using cervical fascia for duraplasty in the surgical treatment of CM-I and analyze and discuss complications from a prospective database spanning 2003-2016. RESULTS The authors found that cervical fascia can be harvested in patients of all ages (2-61 years old) without difficulty, and it provides a good substitute for dura in creating an expansile duraplasty in patients with CM-I. Cervical fascia is an elastic-like material with a consistency that allows for a strong watertight closure. Harvesting the cervical fascia graft does not require any further extension of the incision superiorly or inferiorly to obtain the graft. Complications were uncommon in this study of 123 children and adults. The risk of any type of complication (aseptic meningitis, CSF leak, pseudomeningocele, infection, development of hydrocephalus, and need for ventriculoperitoneal shunt) for the 78 patients in the pediatric age group was 0%. The risk of complication in the adult group was 6.7% (1 patient with aseptic meningitis and 2 patients with CSF leak). CONCLUSIONS Autologous cervical fascia is easy to obtain in patients of all ages and provides an effective material for duraplasty in the treatment of CM-I. Complications from the combination of both an extradural and intradural decompression with autologous cervical fascia duraplasty are uncommon.
关于I型Chiari畸形（CM-I）联合硬膜外和硬膜内减压及扩张性硬脑膜成形术的技术已有详细描述，多种同种异体和自体材料用于硬脑膜成形术。然而，资深作者在20世纪90年代治疗CM-I时所采用的硬脑膜成形术的手术入路和技术尚未见报道。方法：2003年3月建立了一个前瞻性数据库，记录使用颈筋膜进行硬脑膜成形术的情况，并详细记录患有和未患有脊髓空洞症的CM-I儿童和成人手术治疗期间的并发症。2003年3月至2016年6月，共对379例患者进行了389例CM-I手术。对123例患者进行了123例后路手术，均进行了后颅窝硬膜外和硬膜内减压及硬脑膜成形术（硬膜外-硬膜内联合）。本文作者描述了在CM-I手术治疗中获取和使用颈筋膜进行硬脑膜成形术的手术技术，并分析和讨论了2003 - 2016年前瞻性数据库中的并发症。结果：作者发现所有年龄段（2 - 61岁）的患者获取颈筋膜均无困难，它为CM-I患者进行扩张性硬脑膜成形术提供了良好的硬脑膜替代物。颈筋膜是一种类似弹性的材料，其质地允许进行牢固的水密缝合。获取颈筋膜移植物无需向上或向下进一步延长切口来获取移植物。在这项对123例儿童和成人的研究中并发症并不常见。儿科年龄组的78例患者发生任何类型并发症（无菌性脑膜炎、脑脊液漏、假性脑脊膜膨出、感染、脑积水形成以及需要脑室腹腔分流）的风险为0%。成人组的并发症风险为6.7%（1例无菌性脑膜炎患者和2例脑脊液漏患者）。结论：自体颈筋膜在各年龄段患者中都易于获取，为CM-I治疗中的硬脑膜成形术提供了一种有效的材料。自体颈筋膜硬脑膜成形术联合硬膜外和硬膜内减压的并发症并不常见。
