Comparison of dural grafts in Chiari decompression surgery: Review of the literature
TLDR
This review critically reviewed the literature to elucidate the risks and benefits of different graft types and to clarify optimal treatment options therein and did not support the superiority of either autologous or nonautologous grafts when duraplasty is employed.Abstract:
Background: Decompression of Chiari malformation is a common procedure in both pediatric and adult neurosurgery. Although the necessity for some bony removal is universally accepted, other aspects of Chiari surgery are the subject of debate. The most controversial points include the optimal amount of bony removal, the use of duraplasty (and the type of material), the need for subarachnoid dissection, and the need for tonsillar shrinkage. Material and Methods: We critically reviewed the literature to elucidate the risks and benefits of different graft types and to clarify optimal treatment options therein. Based on our search results, 108 relevant articles were identified. With specific inclusion and exclusion criteria, we noted three studies that directly compared two tlpes of dural substitutes in Chiari malformation surgery. Results: Our review did not support the superiority of either autologous or nonautologous grafts when duraplasty is employed. Our institutional experience, however, dictates that when the pericranium is available and of good quality, it should be utilized for duraplasty. It is non-immunogenic, inexpensive, and capable of creating a watertight closure with the dura. Conclusions: Discrepancies between the three comparative studies analyzed are likely attributable to increases in pericranial quality and thickness with maturity. Future randomized studies with large numbers and the power to resolve differences in the relatively low rates of complications in Chiari surgery are warranted.read more
Citations
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Surgical treatment of Chiari I malformation--analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions.
TL;DR: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results and decompressions performed by surgeons experienced with this pathology offer a favorable long-term prognosis.
Journal ArticleDOI
Patterns in neurosurgical adverse events: intracranial neoplasm surgery.
Judith M. Wong,Jaykar R. Panchmatia,John E. Ziewacz,Angela M. Bader,Ian F. Dunn,Edward R. Laws,Atul A. Gawande,Atul A. Gawande +7 more
TL;DR: A significant proportion of adverse events in intracranial neoplasm surgery may be avoidable by use of practices to encourage use of standardized protocols for DVT, seizure, and infection prophylaxis; intraoperative navigation among other steps; improved teamwork and communication; and concentrated volume and specialization.
Journal ArticleDOI
Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I
Silky Chotai,Azedine Medhkour +1 more
TL;DR: The present study reports favorable surgical outcomes with extra-dural decompression of the posterior fossa in patients CM-I without syringomyelia; using extradural dura-splitting and intradural intraarachnoid techniques.
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Augmented autologous pericranium duraplasty in 100 posterior fossa surgeries--a retrospective case series.
Fred C. Lam,Ekkehard M. Kasper +1 more
TL;DR: Autologous pericranium with dural sealant augmentation is an effective way to repair the durotomy in p-fossa surgeries and is the largest study using this technique in the adult neurosurgical literature, reports a much lower rate of complications in comparison with other duraplasty studies.
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Posterior fossa decompression with and without duraplasty for the treatment of Chiari malformation type I-a systematic review and meta-analysis.
TL;DR: Although PFDD is related with longer operation time and higher CSF leak rate, it can still be considered as a preferable treatment option for most CM-I patients for its higher improvement rate.
References
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Creutzfeldt-Jakob disease probably acquired from a cadaveric dura mater graft: Case report
Vijay M. Thadani,Paul L. Penar,Jonathan Partington,Robert G. Kalb,Robert Janssen,Lawrence B. Schonberger,Charles S. Rabkin,James W. Prichard +7 more
TL;DR: Cadaveric dura should be added to the list of materials that may transmit CJD, and it must be very carefully screened if it is used at all for grafting.
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Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia.
Ilyas Munshi,David M. Frim,Roberta Stine-Reyes,Bryce Weir,Javad Hekmatpanah,Frederick D. Brown +5 more
TL;DR: PFD, C1 laminectomy, and duraplasty for the treatment of Chiari I malformation may lead to a more reliable reduction in the volume of concomitant hydromyelia, compared with PFD and C1laminectomy alone.
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Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis
TL;DR: Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications and there was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.
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International survey on the management of Chiari I malformation and syringomyelia
TL;DR: There was a consensus that decompression of the Chiari malformation should be performed in patients with scoliosis when syringomyelia is present, and the majority decompressed the ChiARI malformation in scoliotic patients even in the absence of syringsomyelia.
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Current Opinions for the Treatment of Syringomyelia and Chiari Malformations: Survey of the Pediatric Section of the American Association of Neurological Surgeons
TL;DR: Although many respondents agreed on the management and surgical treatment of symptomatic patients with syringomyelia and/or Chiari malformations, there was disagreement with regard to the optimal surgical procedure.