Dural augmentation approaches and complication rates after posterior fossa decompression for Chiari I malformation and syringomyelia: a Park-Reeves Syringomyelia Research Consortium study

被引：22

作者：

Yahanda, Alexander T. ^{[1
]}

Adelson, P. David ^{[2
]}

Akbari, S. Hassan A. ^{[3
]}

Albert, Gregory W. ^{[4
]}

Aldana, Philipp R. ^{[5
]}

Alden, Tord D. ^{[6
]}

Anderson, Richard C. E. ^{[7
]}

Bauer, David F. ^{[8
]}

Bethel-Anderson, Tammy ^{[1
]}

Brockmeyer, Douglas L. ^{[9
]}

Chern, Joshua J. ^{[10
]}

Couture, Daniel E. ^{[11
]}

Daniels, David J. ^{[12
]}

Dlouhy, Brian J. ^{[13
]}

Durham, Susan R. ^{[14
]}

Ellenbogen, Richard G. ^{[15
]}

Eskandari, Ramin ^{[16
]}

George, Timothy M. ^{[17
]}

Grant, Gerald A. ^{[18
]}

Graupman, Patrick C. ^{[19
]}

Greene, Stephanie ^{[20
]}

Greenfield, Jeffrey P. ^{[21
]}

Gross, Naina L. ^{[22
]}

Guillaume, Daniel J. ^{[23
]}

Hankinson, Todd C. ^{[24
]}

Heuer, Gregory G. ^{[25
]}

Iantosca, Mark ^{[26
]}

Iskandar, Bermans J. ^{[27
]}

Jackson, Eric M. ^{[28
]}

Johnston, James M. ^{[3
]}

Keating, Robert F. ^{[29
]}

Krieger, Mark D. ^{[30
]}

Leonard, Jeffrey R. ^{[31
]}

Maher, Cormac O. ^{[32
]}

Mangano, Francesco T. ^{[33
]}

McComb, J. Gordon ^{[30
]}

McEvoy, Sean D. ^{[1
]}

Meehan, Thanda ^{[1
]}

Menezes, Arnold H. ^{[13
]}

O'Neill, Brent R. ^{[24
]}

Olavarria, Greg ^{[34
]}

Ragheb, John ^{[35
]}

Selden, Nathan R. ^{[36
,37
]}

Shah, Manish N. ^{[38
]}

Shannon, Chevis N. ^{[39
]}

Shimony, Joshua S. ^{[40
]}

Smyth, Matthew D. ^{[1
]}

Stone, Scellig S. D. ^{[41
]}

Strahle, Jennifer M. ^{[1
]}

Torner, James C. ^{[13
]}

机构：

[1] Washington Univ, Sch Med, Dept Neurol Surg, St Louis, MO USA

[2] Phoenix Childrens Hosp, Barrow Neurol Inst, Div Pediat Neurosurg, Phoenix, AZ USA

[3] Univ Alabama Birmingham, Div Pediat Neurosurg, Birmingham, AL USA

[4] Arkansas Childrens Hosp, Div Neurosurg, 800 Marshall St, Little Rock, AR 72202 USA

[5] Univ Florida, Coll Med, Div Pediat Neurosurg, Jacksonville, FL USA

[6] Ann & Robert H Lurie Childrens Hosp Chicago, Div Pediat Neurosurg, Chicago, IL 60611 USA

[7] Childrens Hosp New York, Dept Neurol Surg, Div Pediat Neurosurg, New York, NY USA

[8] Dartmouth Hitchcock Med Ctr, Dept Neurosurg, Lebanon, NH 03766 USA

[9] Primary Childrens Med Ctr, Div Pediat Neurosurg, Salt Lake City, UT USA

[10] Childrens Healthcare Atlanta, Div Pediat Neurosurg, Atlanta, GA USA

[11] Wake Forest Univ, Bowman Gray Sch Med, Dept Neurol Surg, Winston Salem, NC USA

[12] Mayo Clin, Dept Neurosurg, Rochester, MN USA

[13] Univ Iowa Hosp & Clin, Dept Neurosurg, Iowa City, IA 52242 USA

[14] Univ Vermont, Dept Neurosurg, Burlington, VT USA

[15] Seattle Childrens Hosp, Div Pediat Neurosurg, Seattle, WA USA

[16] Med Univ South Carolina, Dept Neurosurg, Charleston, SC 29425 USA

[17] Childrens Med Ctr, Div Pediat Neurosurg, Austin, TX USA

[18] Lucile Packard Childrens Hosp, Div Pediat Neurosurg, Palo Alto, CA USA

[19] Gillette Childrens Hosp, Div Pediat Neurosurg, St Paul, MN USA

[20] Univ Pittsburgh, Childrens Hosp Pittsburgh, Med Ctr, Div Pediat Neurosurg, Pittsburgh, PA 15213 USA

[21] NewYork Presbyterian Hosp, Weill Cornell Med Coll, Dept Neurol Surg, New York, NY USA

[22] Univ Oklahoma, Dept Neurosurg, Oklahoma City, OK USA

[23] Univ Minnesota, Sch Med, Dept Neurosurg, Minneapolis, MN 55455 USA

[24] Childrens Hosp Colorado, Dept Neurosurg, Aurora, CO USA

[25] Univ Penn, Perelman Sch Med, Childrens Hosp Penn, Div Pediat Neurosurg, Philadelphia, PA 19104 USA

[26] Penn State Milton S Hershey Med Ctr, Dept Neurosurg, Hershey, PA USA

[27] Univ Wisconsin Madison, Dept Neurol Surg, Madison, WI USA

[28] Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA

[29] Childrens Natl Med Ctr, Dept Neurosurg, Washington, DC 20010 USA

[30] Childrens Hosp Los Angeles, Div Pediat Neurosurg, Los Angeles, CA 90027 USA

[31] Nationwide Childrens Hosp, Div Pediat Neurosurg, Columbus, OH USA

[32] Univ Michigan, Dept Neurosurg, Ann Arbor, MI 48109 USA

[33] Cincinnati Childrens Med Ctr, Div Pediat Neurosurg, Cincinnati, OH USA

[34] Arnold Palmer Hosp Children, Div Pediat Neurosurg, Orlando, FL USA

[35] Univ Miami, Sch Med, Dept Neurol Surg, Miami, FL 33136 USA

[36] Oregon Hlth & Sci Univ, Dept Neurol Surg, Portland, OR 97201 USA

[37] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Portland, OR 97201 USA

[38] McGovern Med Sch, Div Pediat Neurosurg, Houston, TX USA

[39] Vanderbilt Univ, Monroe Carell Jr Childrens Hosp, Div Pediat Neurosurg, 221 Kirkland Hall, Nashville, TN 37235 USA

[40] Washington Univ, Sch Med, Dept Radiol, St Louis, MO 63110 USA

[41] Boston Childrens Hosp, Div Pediat Neurosurg, Boston, MA USA

[42] All Childrens Hosp, Neurosci Inst, Dept Neurosurg, St Petersburg, FL USA

[43] Carolina Neurosurg & Spine Associates, Charlotte, NC USA

[44] Texas Childrens Hosp, Div Pediat Neurosurg, Houston, TX 77030 USA

来源：

JOURNAL OF NEUROSURGERY-PEDIATRICS | 2021年 / 27卷 / 04期

关键词：

Chiari I malformation; dural augmentation; duraplasty; Park-Reeves; posterior fossa decompression; syringomyelia;

D O I：

10.3171/2020.8.PEDS2087

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECTIVE Posterior fossa decompression with duraplasty (PFDD) is commonly performed for Chiari I malformation (CM-I) with syringomyelia (SM). However, complication rates associated with various dural graft types are not well established. The objective of this study was to elucidate complication rates within 6 months of surgery among autograft and commonly used nonautologous grafts for pediatric patients who underwent PFDD for CM-I/SM. METHODS The Park-Reeves Syringomyelia Research Consortium database was queried for pediatric patients who had undergone PFDD for CM-I with SM. All patients had tonsillar ectopia >= 5 mm, syrinx diameter >= 3 mm, and >= 6 months of postoperative follow-up after PFDD. Complications (e.g., pseudomeningocele, CSF leak, meningitis, and hydrocephalus) and postoperative changes in syrinx size, headaches, and neck pain were compared for autograft versus nonautologous graft. RESULTS A total of 781 PFDD cases were analyzed (359 autograft, 422 nonautologous graft). Nonautologous grafts included bovine pericardium (n = 63), bovine collagen (n = 225), synthetic (n = 99), and human cadaveric allograft (n = 35). Autograft (103/359, 28.7%) had a similar overall complication rate compared to nonautologous graft (143/422, 33.9%) (p = 0.12). However, nonautologous graft was associated with significantly higher rates of pseudomeningocele (p = 0.04) and meningitis (p < 0.001). The higher rate of meningitis was influenced particularly by the higher rate of chemical meningitis (p = 0.002) versus infectious meningitis (p = 0.132). Among 4 types of nonautologous grafts, there were differences in complication rates (p = 0.02), including chemical meningitis (p = 0.01) and postoperative nausea/ vomiting (p = 0.03). Allograft demonstrated the lowest complication rates overall (14.3%) and yielded significantly fewer complications compared to bovine collagen (p = 0.02) and synthetic (p = 0.003) grafts. Synthetic graft yielded higher complication rates than autograft (p = 0.01). Autograft and nonautologous graft resulted in equal improvements in syrinx size (p < 0.0001). No differences were found for postoperative changes in headaches or neck pain. CONCLUSIONS In the largest multicenter cohort to date, complication rates for dural autograft and nonautologous graft are similar after PFDD for CM-I/SM, although nonautologous graft results in higher rates of pseudomeningocele and meningitis. Rates of meningitis differ among nonautologous graft types. Autograft and nonautologous graft are equivalent for reducing syrinx size, headaches, and neck pain.

引用

页码：459 / 468

页数：10

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