Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

Kshettry, Varun R.; Lobo, Bjorn; Lim, Joshua; Sade, Burak; Oya, Soichi; Lee, Joung H.

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자료유형: 학술저널

저자정보: Kshettry, Varun R. (Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic) Lobo, Bjorn (Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic) Lim, Joshua (Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic) Sade, Burak (Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic) Oya, Soichi (Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic) Lee, Joung H. (Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제59권 제1호

발행연도: 2016.1

수록면: 52 - 57 (6page)

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Objective : Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. Methods : We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. Results : Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). Conclusion : When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

#Posterior fossa #Cerebrospinal fluid leak #Duraplasty #Dural reconstruction #Collagen matrix #Pseudomeningocele

참고문헌 (33)

참고문헌 신청

Barth M / 2008 / Watertight dural closure : is it necessary? A prospective randomized trial in patients with supratentorial craniotomies / Neurosurgery 63(4 Suppl 2):352~358

Bejjani GK / 2007 / Durasis Study Group : Safety and efficacy of the porcine small intestinal submucosa dural substitute : results of a prospective multicenter study and literature review / J Neurosurg 106:1028~1033

Boogaarts JD / 2005 / Use of a novel absorbable hydrogel for augmentation of dural repair : results of a preliminary clinical study / Neurosurgery 57(1 Suppl):146~151

Brennan JW / 2001 / Cerebrospinal fluid leak after acoustic neuroma surgery : influence of tumor size and surgical approach on incidence and response to treatment / J Neurosurg 94:217~223

Danish SF / 2006 / Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations / J Neurosurg 104(1 Suppl):16~20

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