Duraplasty with Cervical Fascia Autograft to Reduce Postoperative Complications of Posterior Fossa Tumor Surgery with Suboccipital Midline Approach.
Adolescent
Adult
Aged
Astrocytoma
/ surgery
Biocompatible Materials
/ therapeutic use
Brain Stem Neoplasms
/ surgery
Cerebellar Neoplasms
/ surgery
Cerebral Ventricle Neoplasms
/ surgery
Cerebrospinal Fluid Leak
/ epidemiology
Child
Child, Preschool
Dura Mater
/ surgery
Ependymoma
/ surgery
Fascia
/ transplantation
Female
Fourth Ventricle
Hemangioblastoma
/ surgery
Hemangioma, Cavernous, Central Nervous System
/ surgery
Humans
Infant
Infratentorial Neoplasms
/ surgery
Male
Medulloblastoma
/ surgery
Meningioma
/ surgery
Meningitis
/ epidemiology
Meningocele
/ epidemiology
Middle Aged
Neck
Neurosurgical Procedures
/ methods
Postoperative Complications
/ epidemiology
Plastic Surgery Procedures
/ methods
Retrospective Studies
Transplantation, Autologous
Young Adult
Cerebrospinal fluid leak
Meningitis
Posterior fossa tumor
Pseudomeningocele
Suboccipital midline approach
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
21
08
2019
revised:
18
11
2019
accepted:
19
11
2019
pubmed:
1
12
2019
medline:
10
3
2020
entrez:
1
12
2019
Statut:
ppublish
Résumé
The suboccipital midline approach is common dealing with posterior fossa tumors but has a high risk of postoperative complications, such as pseudomeningocele, cerebrospinal fluid (CSF) leak, and meningitis. Neurosurgeons used various kinds of method to lower its rate. A retrospective, single-center review of patients diagnosed with posterior fossa tumor underwent a suboccipital midline approach. Compare the rates of pseudomeningocele, CSF leak, and meningitis between 2 groups (artificial dura mater or cervical fascia autograft). We get the cervical fascia autograft from the superficial layer of deep cervical fascia just above the trapezius. Our retrospective review involved 123 patients matching the inclusion criteria between January 2009 and April 2019. The complication rate of pseudomeningocele, CSF leak and meningitis were 8.9%, 4.9%, and 17.9%, respectively. The presence of pseudomeningocele or CSF leak for group "artificial" was 11 of 75 (14.67%) and for group "autograft" it was 3 of 48 (6.25%). The rate of meningitis for group "artificial" (24.0%, 18 of 75) was significantly higher (P = 0.027) than the one for group "autograft" (8.33%, 4 of 48). Multivariate regression analysis suggested that the age was negatively correlated with postoperative pseudomeningocele or CSF leak (P = 0.006), with meningitis (P < 0.001). Using cervical fascia autograft decreased the rate of meningitis (P = 0.021) while showing no statistically significant clinical impact on pseudomeningocele or CSF leak. Applying the cervical fascia autograft to reconstruct the dura during posterior fossa surgery is a simple and effective method to reduce the rate of meningitis as compared with artificial dura mater.
Sections du résumé
BACKGROUND
BACKGROUND
The suboccipital midline approach is common dealing with posterior fossa tumors but has a high risk of postoperative complications, such as pseudomeningocele, cerebrospinal fluid (CSF) leak, and meningitis. Neurosurgeons used various kinds of method to lower its rate.
METHODS
METHODS
A retrospective, single-center review of patients diagnosed with posterior fossa tumor underwent a suboccipital midline approach. Compare the rates of pseudomeningocele, CSF leak, and meningitis between 2 groups (artificial dura mater or cervical fascia autograft). We get the cervical fascia autograft from the superficial layer of deep cervical fascia just above the trapezius.
RESULTS
RESULTS
Our retrospective review involved 123 patients matching the inclusion criteria between January 2009 and April 2019. The complication rate of pseudomeningocele, CSF leak and meningitis were 8.9%, 4.9%, and 17.9%, respectively. The presence of pseudomeningocele or CSF leak for group "artificial" was 11 of 75 (14.67%) and for group "autograft" it was 3 of 48 (6.25%). The rate of meningitis for group "artificial" (24.0%, 18 of 75) was significantly higher (P = 0.027) than the one for group "autograft" (8.33%, 4 of 48). Multivariate regression analysis suggested that the age was negatively correlated with postoperative pseudomeningocele or CSF leak (P = 0.006), with meningitis (P < 0.001). Using cervical fascia autograft decreased the rate of meningitis (P = 0.021) while showing no statistically significant clinical impact on pseudomeningocele or CSF leak.
CONCLUSIONS
CONCLUSIONS
Applying the cervical fascia autograft to reconstruct the dura during posterior fossa surgery is a simple and effective method to reduce the rate of meningitis as compared with artificial dura mater.
Identifiants
pubmed: 31785439
pii: S1878-8750(19)32946-8
doi: 10.1016/j.wneu.2019.11.106
pii:
doi:
Substances chimiques
Biocompatible Materials
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1115-e1120Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.