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  • Safety and Effectiveness of Pericranial Autograft with Fibrin Sealant Augmentation for Duraplasty in Posterior-fossa Decompressions: A Review of 103 Cases

    Final Number:
    1459

    Authors:
    Fred Chiu-lai Lam MD PhD FRCSC; Ekkehard Matthias Kasper MD PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Posterior fossa surgery is a standard neurosurgical procedure performed worldwide and usually requires the use of some graft-material for dural closure. There are numerous autogenic, allogenic, xenogenic, absorbable, and nonabsorbable materials currently available for use, but few have been thoroughly studied and no superior standard has been established. One concern is that non-autogenous materials have been associated with various complications. Current literature suggests that, when available, tissues, such as autologous pericranium or fascia, represent a cost-effective and inert substrate. A recent report by Stevens et al. has revived interest in this topic[1]. We herein report our experience of 136 cases of posterior fossa surgeries using autologous pericranium for duraplasty.

    Methods: Retrospective review of 136 cases of posterior fossa surgeries using autologous pericranium for duraplasty with fibrin sealant augmentation[2], performed at a single institution. Cases were reviewed radiographically and clinically for postoperative surgical site infection, meningitis, dural graft dehiscence, cerebrospinal fluid leak, and development of a symptomatic pseudomeningocele at 4 weeks, 3 months, 6 months, and 1 year follow-up.

    Results: Of the 136 cases, 1 patient developed a delayed full thickness graft dehiscence requiring revision, and 1 patient developed medication-induced aseptic pleocytosis secondary to an NSAID allergy.

    Conclusions: Autologous pericranium duoplasty with fibrin sealant augmentation is a safe and effective material for dural closure in posterior fossa surgeries. Compared to the literature it produces superior results and may prevent exposure of patients to morbidities associated with other (allograft/xenograft) materials. Further validation is required with a randomized comparison study.

    Patient Care: Use of autologus pericranium will decrease risk of complications associated with non-autologous dural grafts and potential decrease cost secondary to use of expensive dural grafts.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Become familiar with the technique of autologoug pericranium harvesting for duraplasty in p fossa surgeries, 2) Discuss in small groups the different types of dural graft substitutes available today for use, 3) Identify a safe and effective method of duraplasty for p-fossa surgeries.

    References: 1. Stevens, E.A., et al., Simplified harvest of autologous pericranium for duraplasty in Chiari malformation Type I. Technical note. J Neurosurg Spine, 2009. 11(1): p. 80-3. 2. Cosgrove, G.R., et al., Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair. J Neurosurg, 2007. 106(1): p. 52-8.

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