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Closing the dura: dural hitching versus surgicel and tisseel overlay graft in craniocervicaldecompression for Chiari 1 malformation.
Br J Neurosurg. 2017 Aug; 31(4):422-425.BJ

Abstract

BACKGROUND

This study compares dural hitching to surgicel and tisseel overlay graft following craniocervical decompression and C1 laminectomy with simple durotomy for Chiari I malformation. Outcome measures were syrinx decompression, headache resolution and complication rates.

METHODS

A retrospective analysis of case notes was conducted. Patients who had undergone craniocervical decompression (CCD) were grouped by method of dural closure. Outcomes compared were rates of syrinx decompression, headache resolution, and post-operative complications. Statistical analysis was conducted using SPSS v20.

RESULTS

We identified 32 adult patients for inclusion in this study. 53.1% (n = 17) had asyrinx, and 78.1% (n = 25) had a pre-operative headache. All were treated with suboccipital craniectomy, C1 laminectomy (with or without C2 laminectomy), and durotomy. The dura was either left open by dural hitching (n = 23) or closed with surgicel and tisseel overlay graft (n = 9). We found a statistically significant association between the method of dural closure and the rate of syrinx resolution. Resolution occurred in 91.7% (n = 11) of the hitching group, compared to 20.0% (n = 1) of the overlay graft group: Χ2(1) = 5.6, p = .018. There were no statistically significant differences between the two groups in the rates of headache resolution or other complications.

CONCLUSIONS

In patients with symptomatic Chiari I malformation and associated syringomyelia, syrinx resolution is more likely if the dura is hitched open rather than closed bysurgicel and tisseel overlay graft after durotomy.

Authors+Show Affiliations

a The Medical School , University of Sheffield , Sheffield , South Yorkshire , UK.b Department of Neurosurgery , Queen Elizabeth Hospital , Birmingham , West Midlands , UK.a The Medical School , University of Sheffield , Sheffield , South Yorkshire , UK.c Department of Neurosurgery , Royal Hallamshire Hospital , Sheffield , South Yorkshire , UK.c Department of Neurosurgery , Royal Hallamshire Hospital , Sheffield , South Yorkshire , UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28637109

Citation

Tonkins, Michael, et al. "Closing the Dura: Dural Hitching Versus Surgicel and Tisseel Overlay Graft in Craniocervicaldecompression for Chiari 1 Malformation." British Journal of Neurosurgery, vol. 31, no. 4, 2017, pp. 422-425.
Tonkins M, Farooqi N, Ahmed R, et al. Closing the dura: dural hitching versus surgicel and tisseel overlay graft in craniocervicaldecompression for Chiari 1 malformation. Br J Neurosurg. 2017;31(4):422-425.
Tonkins, M., Farooqi, N., Ahmed, R., Sinha, S., & Bhattacharyya, D. (2017). Closing the dura: dural hitching versus surgicel and tisseel overlay graft in craniocervicaldecompression for Chiari 1 malformation. British Journal of Neurosurgery, 31(4), 422-425. https://doi.org/10.1080/02688697.2017.1297363
Tonkins M, et al. Closing the Dura: Dural Hitching Versus Surgicel and Tisseel Overlay Graft in Craniocervicaldecompression for Chiari 1 Malformation. Br J Neurosurg. 2017;31(4):422-425. PubMed PMID: 28637109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Closing the dura: dural hitching versus surgicel and tisseel overlay graft in craniocervicaldecompression for Chiari 1 malformation. AU - Tonkins,Michael, AU - Farooqi,Naeem, AU - Ahmed,Rohan, AU - Sinha,Saurabh, AU - Bhattacharyya,Debapriya, Y1 - 2017/03/02/ PY - 2017/6/24/pubmed PY - 2018/8/22/medline PY - 2017/6/23/entrez KW - Chiari type 1 malformation KW - craniovertebral junction KW - syringomyelia KW - syrinx SP - 422 EP - 425 JF - British journal of neurosurgery JO - Br J Neurosurg VL - 31 IS - 4 N2 - BACKGROUND: This study compares dural hitching to surgicel and tisseel overlay graft following craniocervical decompression and C1 laminectomy with simple durotomy for Chiari I malformation. Outcome measures were syrinx decompression, headache resolution and complication rates. METHODS: A retrospective analysis of case notes was conducted. Patients who had undergone craniocervical decompression (CCD) were grouped by method of dural closure. Outcomes compared were rates of syrinx decompression, headache resolution, and post-operative complications. Statistical analysis was conducted using SPSS v20. RESULTS: We identified 32 adult patients for inclusion in this study. 53.1% (n = 17) had asyrinx, and 78.1% (n = 25) had a pre-operative headache. All were treated with suboccipital craniectomy, C1 laminectomy (with or without C2 laminectomy), and durotomy. The dura was either left open by dural hitching (n = 23) or closed with surgicel and tisseel overlay graft (n = 9). We found a statistically significant association between the method of dural closure and the rate of syrinx resolution. Resolution occurred in 91.7% (n = 11) of the hitching group, compared to 20.0% (n = 1) of the overlay graft group: Χ2(1) = 5.6, p = .018. There were no statistically significant differences between the two groups in the rates of headache resolution or other complications. CONCLUSIONS: In patients with symptomatic Chiari I malformation and associated syringomyelia, syrinx resolution is more likely if the dura is hitched open rather than closed bysurgicel and tisseel overlay graft after durotomy. SN - 1360-046X UR - https://www.unboundmedicine.com/medline/citation/28637109/Closing_the_dura:_dural_hitching_versus_surgicel_and_tisseel_overlay_graft_in_craniocervicaldecompression_for_Chiari_1_malformation_ L2 - https://www.tandfonline.com/doi/full/10.1080/02688697.2017.1297363 DB - PRIME DP - Unbound Medicine ER -