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Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations.
J Neurosurg. 2006 Jan; 104(1 Suppl):16-20.JN

Abstract

OBJECT

Posterior fossa decompression with duraplasty is routinely used for the treatment of Chiari malformations. It has been traditionally believed that this procedure requires a watertight seal with primary closure of the dura with either pericranium or allograft. In this study, the authors evaluated two synthetic dural substitutes in this patient population for feasibility of use and identification of perioperative morbidity.

METHODS

The authors evaluated 56 patients who underwent duraplasty with a synthetic collagen matrix (DuraGen) after suboccipital craniectomy and C-1 laminectomy, and 45 patients in whom the dural closure involved acellular human dermis (AlloDerm). Patients in both groups were assessed for the presence of a pseudomeningocele, wound infection, cerebrospinal fluid (CSF) leak, and the need for repeated operation either for wound revision or the placement of a ventriculoperitoneal shunt. Operative times for which DuraGen duraplasty was used were compared with those for AlloDerm closure. In the DuraGen group, complications included five pseudomeningoceles (8.9%), two wound infections (3.6%), one CSF leak (1.8%), and four repeated operations (three shunt revisions and one reexploration; 7.1%) in nine patients. In the AlloDerm group, there were five pseudomeningoceles (11.1%), one wound infection (2.2%), one CSF leak (2.2%), and two repeated operations (two shunt revisions; 4.4%) in seven patients. The operative time associated with DuraGen was significantly shorter than that of duraplasty that required closure with sutures (92 minutes compared with 128 minutes, p < 0.01).

CONCLUSIONS

The synthetic dural substitutes DuraGen and AlloDerm provide a suitable alternative duraplasty with comparable complication rates. DuraGen requires a significantly shorter operative time than AlloDerm.

Authors+Show Affiliations

Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania, USA. danishs@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

16509475

Citation

Danish, Shabbar F., et al. "Experience With Acellular Human Dura and Bovine Collagen Matrix for Duraplasty After Posterior Fossa Decompression for Chiari Malformations." Journal of Neurosurgery, vol. 104, no. 1 Suppl, 2006, pp. 16-20.
Danish SF, Samdani A, Hanna A, et al. Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. J Neurosurg. 2006;104(1 Suppl):16-20.
Danish, S. F., Samdani, A., Hanna, A., Storm, P., & Sutton, L. (2006). Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. Journal of Neurosurgery, 104(1 Suppl), 16-20.
Danish SF, et al. Experience With Acellular Human Dura and Bovine Collagen Matrix for Duraplasty After Posterior Fossa Decompression for Chiari Malformations. J Neurosurg. 2006;104(1 Suppl):16-20. PubMed PMID: 16509475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. AU - Danish,Shabbar F, AU - Samdani,Amer, AU - Hanna,Amgad, AU - Storm,Phillip, AU - Sutton,Leslie, PY - 2006/3/3/pubmed PY - 2006/3/15/medline PY - 2006/3/3/entrez SP - 16 EP - 20 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 104 IS - 1 Suppl N2 - OBJECT: Posterior fossa decompression with duraplasty is routinely used for the treatment of Chiari malformations. It has been traditionally believed that this procedure requires a watertight seal with primary closure of the dura with either pericranium or allograft. In this study, the authors evaluated two synthetic dural substitutes in this patient population for feasibility of use and identification of perioperative morbidity. METHODS: The authors evaluated 56 patients who underwent duraplasty with a synthetic collagen matrix (DuraGen) after suboccipital craniectomy and C-1 laminectomy, and 45 patients in whom the dural closure involved acellular human dermis (AlloDerm). Patients in both groups were assessed for the presence of a pseudomeningocele, wound infection, cerebrospinal fluid (CSF) leak, and the need for repeated operation either for wound revision or the placement of a ventriculoperitoneal shunt. Operative times for which DuraGen duraplasty was used were compared with those for AlloDerm closure. In the DuraGen group, complications included five pseudomeningoceles (8.9%), two wound infections (3.6%), one CSF leak (1.8%), and four repeated operations (three shunt revisions and one reexploration; 7.1%) in nine patients. In the AlloDerm group, there were five pseudomeningoceles (11.1%), one wound infection (2.2%), one CSF leak (2.2%), and two repeated operations (two shunt revisions; 4.4%) in seven patients. The operative time associated with DuraGen was significantly shorter than that of duraplasty that required closure with sutures (92 minutes compared with 128 minutes, p < 0.01). CONCLUSIONS: The synthetic dural substitutes DuraGen and AlloDerm provide a suitable alternative duraplasty with comparable complication rates. DuraGen requires a significantly shorter operative time than AlloDerm. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/16509475/Experience_with_acellular_human_dura_and_bovine_collagen_matrix_for_duraplasty_after_posterior_fossa_decompression_for_Chiari_malformations_ L2 - https://thejns.org/doi/10.3171/ped.2006.104.1.16 DB - PRIME DP - Unbound Medicine ER -