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Augmented Autologous Pericranium Duraplasty in 100 Posterior Fossa SurgeriesA Retrospective Case Series

Lam, Fred C. MD, PhD; Kasper, Ekkehard MD, PhD

doi: 10.1227/NEU.0b013e31826a8ab0
Technique Assessment

BACKGROUND: Primary closure of the dura in posterior fossa (p-fossa) surgeries is technically difficult and usually requires the use of a dural substitute. A variety of substitutes are currently available and data suggest that autologous materials are preferred in comparison with nonautologous substitutes.

OBJECTIVE: To report our experience using locally harvested autologous pericranium as a dural substitute in patients who underwent p-fossa surgeries.

METHODS: Retrospective analysis of patients who had undergone p-fossa craniotomies between 2005 and 2011. All patients received locally harvested autologous pericranium for duraplasty augmented with a dural sealant. Data were reviewed for complications including: surgical site infection, meningitis, cerebrospinal fluid leak, the radiographic formation of a pseudomeningocele, and any new neurological symptoms related to the incision or repair.

RESULTS: One hundred patients were identified. Indications for surgery included tumor, vascular lesions, or hemorrhage requiring surgical intervention, symptomatic Chiari I malformation, microvascular decompression for trigeminal neuralgia, and trauma requiring surgical decompression. The complication rate was 1% with 1 patient developing an nonsteroidal anti-inflammatory drug-induced aseptic meningitis and graft dehiscence requiring surgical revision.

CONCLUSION: Autologous pericranium with dural sealant augmentation is an effective way to repair the durotomy in p-fossa surgeries. To the best of our knowledge, this is currently the largest study using this technique in the adult neurosurgical literature. Our results report a much lower rate of complications in comparison with other duraplasty studies.

ABBREVIATIONS: IV, intravenously

NSAID, nonsteroidal anti-inflammatory drug

p-fossa, posterior fossa

Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts

Correspondence: Ekkehard Kasper, MD PhD, Suite 3B, 110 Francis St, Boston, MA 01125. E-mail: ekasper@bidmc.harvard.edu

Received May 08, 2012

Accepted June 05, 2012

Copyright © by the Congress of Neurological Surgeons