Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA.
Oper Neurosurg (Hagerstown). 2021 Nov 15;21(6):386-392. doi: 10.1093/ons/opab343.
Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results.
To compare outcomes between pericranial autograft and AlloDerm (BioHorizons).
Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement.
A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr (11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71).
In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.
在 Chiari 减压术中，使用颅骨膜移植物是一种常用的硬脑膜修复方法，具有多种理论优势，但与其他材料的比较结果却不一致。
比较颅骨膜移植物和 AlloDerm（BioHorizons）在 Chiari 畸形 I 型（CM-I）患者中的应用效果。
在一家单中心医院，连续对接受枕下颅骨切除术的 I 型 Chiari 畸形患者进行了 8 年的回顾性研究。排除标准包括再次手术和未行硬脑膜修补的枕下减压术。研究结果包括切口脑脊液（CSF）漏、住院时间（LOS）、伤口并发症、无菌性脑膜炎、脊髓空洞症改善和症状改善。
共有 101 例患者（70 名女性和 31 名男性）符合纳入标准，年龄中位数（四分位数间距）为 17 岁（11-32 岁）。51 例（50%）患者接受颅骨膜移植物硬脑膜修补，其余患者接受 AlloDerm 硬脑膜修补。9 例（9%）患者术后发生 CSF 漏。调整混杂因素后，肥胖（比值比 [OR]：4.69，95%可信区间：1.03-25.6）和使用 AlloDerm（OR：10.54，95%可信区间：1.7-206.12）与 CSF 漏有关。8 例（8%）患者发生伤口并发症，但与移植物类型无关（P=0.8）。移植物类型与 LOS、脊髓空洞症改善或症状改善无关。10 例患者需要再次手术，其中 4 例在颅骨膜移植物组，6 例在 AlloDerm 组（P=0.71）。
在 CM-I 患者中，与颅骨膜移植物相比，使用 AlloDerm 进行扩张性硬脑膜修补与更高的 CSF 漏风险相关。肥胖也与 CSF 漏的风险增加相关。
