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: email@example.com
Received May 08, 2012
Accepted June 05, 2012