Open AccessDural Closure in Chiari I Malformation. Technique Description and Analysis of Results
Author(s) -
Roger Schmidt Brock,
João Gustavo Rocha Peixoto dos Santos,
Mário Augusto Taricco,
Matheus Fernandes de Oliveira,
Marcelo de Lima Oliveira,
Manoel Jacobsen Teixeira,
Edson BorSengShu
Publication year - 2018
Publication title -
jornal brasileiro de neurocirurgia
Language(s) - English
Resource type - Journals
eISSN - 2446-6786
pISSN - 0103-5118
DOI - 10.22290/jbnc.v28i2.1689
Subject(s) - pseudomeningocele , medicine , surgery , decompression , laminectomy , meningitis , complication , spinal cord , psychiatry
. Surgical posterior fossa decompression of Chiari malformation type 1 (CM-I) is recommended in symptomatic patients. The classic surgery is a suboccipital craniectomy and C-1 laminectomy, with duroplasty. However, a range of complications associated with surgical management of CM-I includes pseudomeningocele, CSF leakage, aseptic meningitis, and wound infections, making dural closure and reconstruction one important step to determine morbidity. Our objective is to present a technique of pericranium harvest and dural closure and describe our experience. Methods. A retrospective study was conducted based on records of patients treated in Hospital das Clínicas of the University of São Paulo, diagnosed with CM-I and submitted to posterior fossa decompression from January 2008 until May 2015. We evaluated the occurrence of post-operative complications of symptomatic pseudomeningocele or incisional CSF leak. The occurrence of meningitis, surgical site infection or other complications were also available. Results. A total of 22 patients were evaluated in this study. Sixteen (72.7%) were female patients. Overall, the mean age at the time of surgery was 49 ± 13.6 years-old. Four patients (18%) presented complications: 3 CSF leakages (13.5%) and 1 pseudomeningocele (4.5%). Discussion. Postoperative complications of CM-I are still frequent and determinants of surgical success. We propose a new surgical technique with autologous pericranium graft and duraplasty. Additionally to dural closure, we propose another modality of muscular fascia closure, allowing increased tight closure. Our data corroborate with current literature. Conclusion. Our technique of dural closure using pericranium autologous graft in CM-I is safe and feasible.