Makoshi Ziyad, Toop Nathaniel, Smith Luke G F, Drapeau Annie, Pindrik Jonathan, Sribnick Eric A, Leonard Jeffrey, Shaikhouni Ammar
1Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus; and.
2Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Neurosurg Pediatr. 2022 Sep 9;30(5):507-516. doi: 10.3171/2022.7.PEDS22231. Print 2022 Nov 1.
Dural sealants are commonly used in posterior fossa decompression with duraplasty (PFDD) for Chiari malformation type I (CMI). Prior evidence suggests that combining certain sealants with some graft material is associated with an increased rate of complications. In 2018, the authors noted an increased rate of symptomatic pseudomeningocele and aseptic meningitis after PFDD in CMI patients. The authors utilized retrospective and prospective analyses to test the hypothesis that complication rates increase with the use or combination of certain sealants and grafts.
The analysis was split into 2 periods. The authors retrospectively reviewed patients who underwent PFDD for CMI at their center between August 12, 2011, and December 31, 2018. The authors then eliminated use of DuraSeal on the basis of the retrospective analysis and prospectively examined complication rates from January 1, 2019, to August 4, 2021. The authors defined a complication as symptomatic pseudomeningocele, bacterial or aseptic meningitis, cerebrospinal fluid leak, subdural hygroma, hydrocephalus, surgical site infection, or wound dehiscence.
From 2011 to 2018, complications occurred in 24.5% of 110 patients. Sealant choice was correlated with complication rates: no sealant (0%), Tisseel (6%), and DuraSeal (15.3%) (p < 0.001). No difference in complication rate was noted on the basis of choice of graft material (p = 0.844). After eliminating DuraSeal, the authors followed 40 patients who underwent PFDD after 2018. The complication rate decreased to 12.5%. All complications after 2018 were associated with Tisseel.
At the authors' single center, use of sealants in PFDD surgery for CMI, especially DuraSeal, was correlated with a higher complication rate. Eliminating DuraSeal led to a significant decrease in the rate of symptomatic pseudomeningocele and aseptic meningitis.
硬脑膜封闭剂常用于I型Chiari畸形（CMI）的后颅窝减压硬脑膜成形术（PFDD）。先前的证据表明，某些封闭剂与一些移植材料联合使用会增加并发症发生率。2018年，作者注意到CMI患者PFDD术后有症状的假性脑膜膨出和无菌性脑膜炎发生率增加。作者采用回顾性和前瞻性分析来检验以下假设：特定封闭剂和移植材料的使用或联合使用会增加并发症发生率。
分析分为两个阶段。作者回顾性分析了2011年8月12日至2018年12月31日期间在其中心接受CMI的PFDD手术的患者。然后，基于回顾性分析，作者不再使用DuraSeal，并前瞻性地检查了2019年1月1日至2021年8月4日期间的并发症发生率。作者将并发症定义为有症状的假性脑膜膨出、细菌性或无菌性脑膜炎、脑脊液漏、硬膜下积液、脑积水、手术部位感染或伤口裂开。
2011年至2018年，110例患者中有24.5%发生并发症。封闭剂的选择与并发症发生率相关：未使用封闭剂（0%）、纤维蛋白胶（6%）和DuraSeal（15.3%）（p<0.001）。根据移植材料的选择，并发症发生率无差异（p=0.844）。在排除DuraSeal后，作者随访了2018年后接受PFDD手术的40例患者。并发症发生率降至12.5%。2018年后所有并发症均与纤维蛋白胶有关。
在作者所在的单中心，CMI的PFDD手术中使用封闭剂，尤其是DuraSeal，与较高的并发症发生率相关。排除DuraSeal后，有症状的假性脑膜膨出和无菌性脑膜炎的发生率显著降低。
