J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
Crit Rev Biomed Eng. 2023;51(2):33-44. doi: 10.1615/CritRevBiomedEng.v51.i2.30.
Cerebrospinal fluid (CSF) leakage is a common postoperative complication of neurosurgical procedures, with iatrogenic causes accounting for 16% of CSF leakages. This complication increases healthcare costs and patient morbidity. The focus of this review is to analyze the rates of CSF leakage of some of the most commonly used xenogeneic and synthetic dural substitutes following surgeries in the infratentorial region of the brain where surgical repair can be most challenging. A systematic literature search was conducted using studies detailing duraplasty procedures performed with nonautologous grafts in the infratentorial region in PubMed. Studies were identified using the following search terms: "posterior fossa" or "infratentorial" were used in combination with "CSF leak," "CSF leakage," "cerebrospinal fluid leakage," "duraplasty" or "dura graft." The outcome of interest was a measure of the prevalence of CSF leakage rates following posterior fossa neurosurgery. Studies that contributed data to this review were published between 2006 and 2021. The dural graft materials utilized included: bovine collagen, acellular dermis, equine collagen, bovine pericardium, collagen matrix, and expanded polytetrafluoroethylene (ePTFE). The number of subjects in studies on each of these grafts ranged from 6 to 225. CSF leak rates ranged from 0% to 25% with the predominance of studies reporting between 3% and 15%. The studies that utilize bovine collagen, equine collagen, and acellular dermis reported higher CSF leakage rates; whereas studies that utilized ePTFE, bovine pericardium, and collagen matrix reported lower CSF leakage rates. Due to the heterogeneity of methodologies used across these studies, it is difficult to draw a direct correlation between the dural patch products used and CSF leaks. Larger prospective controlled studies that evaluate various products in a head-to-head fashion, using the same methods and animal models, are needed to conclude the relative efficacy of these dural patch products.
脑脊液（CSF）漏是神经外科手术后的常见并发症，医源性原因占 CSF 漏的 16%。这种并发症增加了医疗保健成本和患者发病率。本综述的重点是分析一些最常用于脑桥小脑角（CPA）手术的异种和合成硬脑膜替代品的 CSF 漏率，在该部位手术修复可能最具挑战性。使用非自体移植物进行硬脑膜修补术的研究在 PubMed 中使用以下搜索词进行了系统文献检索：“后颅窝”或“CPA”与“CSF 漏”、“CSF 泄漏”、“脑脊液漏”、“硬脑膜修补术”或“硬脑膜移植物”组合使用。感兴趣的结果是衡量后颅窝神经外科手术后 CSF 漏率的一种衡量标准。为本次综述提供数据的研究发表于 2006 年至 2021 年之间。硬脑膜移植物材料包括：牛胶原蛋白、脱细胞真皮、马胶原蛋白、牛心包、胶原基质和膨体聚四氟乙烯（ePTFE）。这些移植物中每项研究的受试者数量从 6 到 225 不等。CSF 漏率从 0%到 25%不等，大多数研究报告的漏率在 3%到 15%之间。使用牛胶原蛋白、马胶原蛋白和脱细胞真皮的研究报告的 CSF 漏率较高；而使用 ePTFE、牛心包和胶原基质的研究报告的 CSF 漏率较低。由于这些研究中使用的方法学存在异质性，因此很难直接将使用的硬脑膜补片产品与 CSF 漏相关联。需要进行更大的前瞻性对照研究，以头对头的方式评估各种产品，使用相同的方法和动物模型，以得出这些硬脑膜补片产品的相对疗效。
