Valentini Laura Grazia, Saletti Veronica, Moscatelli Marco, Ferrari Emma, Farinotti Mariangela, Barbotti Arianna, Vetrano Ignazio Gaspare, Galbiati Tommaso Francesco
1Department of Neurosurgery.
2Developmental Neurology Unit, Mariani Foundation Center for Complex Disabilities.
Neurosurg Focus. 2025 Feb 1;58(2):E13. doi: 10.3171/2024.11.FOCUS24710.
This study investigated whether the selection of different dural substitutes and distinct dural repair techniques correlates with the incidence rate of postoperative CSF leak in a mixed population of adults and children with Chiari type I malformation (CM-I) who underwent posterior fossa decompression with enlargement duraplasty (PFDD) as the first surgical approach.
A retrospective analysis was conducted on all patients admitted to the authors' institution between 2006 and 2023 for PFDD to treat syringomyelia and/or symptoms due to CM-I. Clinical, radiological, and surgical data were extracted from a prospectively maintained database. Demographic information was collected from medical records. Surgical procedures were also scrutinized, specifically focusing on the type of dural graft used for duraplasty, alongside perioperative complications and the necessity for subsequent surgeries. Lastly, during follow-up, the occurrence of a CSF leak was assessed and analyzed in relation to the type of dural graft used during surgery. The type of dural substitute chosen changed over the years to reduce CSF fistulas, while the technique of PFDD remained the same. Consequently, large sequential homogeneous groups differing only by dural substitutes were available for comparison.
The data from 409 patients with CM-I undergoing PFDD were analyzed. A total of 368 cases had complete surgical data and were included. Thirty patients received autologous duraplasty. The remaining 338 cases with heterologous duraplasty from equine and bovine pericardium were considered for the comparative statistical analysis. The mean follow-up duration ranged from 39 months in adults to 45 months in children. The CSF complication rate requiring revision was 6.5% in the total cohort, with a higher incidence in children (10.5%) compared with adults (3.9%). There was no significant difference in adverse events (CSF leak, revision surgery, or ventriculoperitoneal shunt placement) between the different dural patches by univariate analysis if applied to the total cohort, although the trend neared significance (p = 0.06). In pediatric cases, this value was significant (p = 0.01) in favor of equine pericardium, particularly when combined with a collagen matrix inlay graft.
This study on a large and homogeneous series of patients with CM-I undergoing PFDD with heterologous duraplasty demonstrated that CSF complications may be kept low. The dural substitutes derived from equine pericardium, particularly when combined with a collagen matrix inlay graft, exhibited a reduced rate of CSF leaks compared with substitutes derived from bovine pericardium.
本研究调查了在以颅后窝减压并扩大硬脑膜成形术（PFDD）作为首次手术方法的成年和儿童I型Chiari畸形（CM-I）混合人群中，不同硬脑膜替代物的选择和不同的硬脑膜修复技术是否与术后脑脊液漏的发生率相关。
对2006年至2023年间因PFDD治疗脊髓空洞症和/或CM-I相关症状而入住作者所在机构的所有患者进行回顾性分析。从一个前瞻性维护的数据库中提取临床、放射学和手术数据。从病历中收集人口统计学信息。还仔细审查了手术过程，特别关注用于硬脑膜成形术的硬脑膜移植物类型，以及围手术期并发症和后续手术的必要性。最后，在随访期间，评估并分析了脑脊液漏的发生情况与手术中使用的硬脑膜移植物类型的关系。多年来选择的硬脑膜替代物类型有所变化以减少脑脊液瘘，而PFDD技术保持不变。因此，可以获得仅因硬脑膜替代物不同的大型连续同质组进行比较。
分析了409例接受PFDD的CM-I患者的数据。共有368例有完整的手术数据并被纳入。30例接受了自体硬脑膜成形术。其余338例采用马和牛心包异种硬脑膜成形术的病例用于比较统计分析。平均随访时间在成人中为39个月，在儿童中为45个月。整个队列中需要翻修的脑脊液并发症发生率为6.5%，儿童中的发生率（10.5%）高于成人（3.9%）。单因素分析显示，如果应用于整个队列，不同硬脑膜补片之间的不良事件（脑脊液漏、翻修手术或脑室腹腔分流置入）没有显著差异，尽管趋势接近显著（p = 0.06）。在儿科病例中，该值具有显著性（p = 0.01），有利于马心包，特别是当与胶原基质镶嵌移植物联合使用时。
这项对大量接受异种硬脑膜成形术PFDD的CM-I同质患者系列研究表明，脑脊液并发症可能保持在较低水平。与牛心包来源的替代物相比，马心包来源的硬脑膜替代物，特别是当与胶原基质镶嵌移植物联合使用时，脑脊液漏发生率降低。
