Alexander T Yahanda1, P David Adelson2, S Hassan A Akbari3, Gregory W Albert4, Philipp R Aldana5, Tord D Alden6, Richard C E Anderson7, David F Bauer8, Tammy Bethel-Anderson1, Douglas L Brockmeyer9, Joshua J Chern10, Daniel E Couture11, David J Daniels12, Brian J Dlouhy13, Susan R Durham14, Richard G Ellenbogen15, Ramin Eskandari16, Timothy M George17, Gerald A Grant18, Patrick C Graupman19, Stephanie Greene20, Jeffrey P Greenfield21, Naina L Gross22, Daniel J Guillaume23, Todd C Hankinson24, Gregory G Heuer25, Mark Iantosca26, Bermans J Iskandar27, Eric M Jackson28, James M Johnston3, Robert F Keating29, Mark D Krieger30, Jeffrey R Leonard31, Cormac O Maher32, Francesco T Mangano33, J Gordon McComb30, Sean D McEvoy1, Thanda Meehan1, Arnold H Menezes13, Brent R O'Neill24, Greg Olavarria34, John Ragheb35, Nathan R Selden36, Manish N Shah37, Chevis N Shannon38, Joshua S Shimony39, Matthew D Smyth1, Scellig S D Stone40, Jennifer M Strahle1, James C Torner13, Gerald F Tuite41, Scott D Wait42, John C Wellons38, William E Whitehead43, Tae Sung Park1, David D Limbrick1. 1. 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO. 2. 2Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ. 3. 3Division of Pediatric Neurosurgery, University of Alabama at Birmingham, AL. 4. 4Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR. 5. 5Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FL. 6. 6Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, IL. 7. 7Division of Pediatric Neurosurgery, Department of Neurological Surgery, Children's Hospital of New York, Columbia-Presbyterian, New York, NY. 8. 8Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 9. 9Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT. 10. 10Division of Pediatric Neurosurgery, Children's Healthcare of Atlanta, GA. 11. 11Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. 12. 12Department of Neurosurgery, Mayo Clinic, Rochester, MN. 13. 13Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA. 14. 14Department of Neurosurgery, University of Vermont, Burlington, VT. 15. 15Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, WA. 16. 16Department of Neurosurgery, Medical University of South Carolina, Charleston, SC. 17. 17Division of Pediatric Neurosurgery, Dell Children's Medical Center, Austin, TX. 18. 18Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Palo Alto, CA. 19. 19Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, MN. 20. 20Division of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. 21. 21Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. 22. 22Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK. 23. 23Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN. 24. 24Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO. 25. 25Division of Pediatric Neurosurgery, Children's Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 26. 26Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA. 27. 27Department of Neurological Surgery, University of Wisconsin at Madison, WI. 28. 28Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. 29. 29Department of Neurosurgery, Children's National Medical Center, Washington, DC. 30. 30Division of Pediatric Neurosurgery, Children's Hospital of Los Angeles, CA. 31. 31Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH. 32. 32Department of Neurosurgery, University of Michigan, Ann Arbor, MI. 33. 33Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OH. 34. 34Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FL. 35. 35Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL. 36. 36Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR. 37. 37Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TX. 38. 38Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN. 39. 39Department of Radiology, Washington University School of Medicine, St. Louis, MO. 40. 40Division of Pediatric Neurosurgery, Boston Children's Hospital, Boston, MA. 41. 41Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, FL. 42. 42Carolina Neurosurgery & Spine Associates, Charlotte, NC; and. 43. 43Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX.
Abstract
OBJECTIVE: Posterior fossa decompression with duraplasty (PFDD) is commonly performed for Chiari I malformation (CM-I) with syringomyelia (SM). However, complication rates associated with various dural graft types are not well established. The objective of this study was to elucidate complication rates within 6 months of surgery among autograft and commonly used nonautologous grafts for pediatric patients who underwent PFDD for CM-I/SM. METHODS: The Park-Reeves Syringomyelia Research Consortium database was queried for pediatric patients who had undergone PFDD for CM-I with SM. All patients had tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and ≥ 6 months of postoperative follow-up after PFDD. Complications (e.g., pseudomeningocele, CSF leak, meningitis, and hydrocephalus) and postoperative changes in syrinx size, headaches, and neck pain were compared for autograft versus nonautologous graft. RESULTS: A total of 781 PFDD cases were analyzed (359 autograft, 422 nonautologous graft). Nonautologous grafts included bovine pericardium (n = 63), bovine collagen (n = 225), synthetic (n = 99), and human cadaveric allograft (n = 35). Autograft (103/359, 28.7%) had a similar overall complication rate compared to nonautologous graft (143/422, 33.9%) (p = 0.12). However, nonautologous graft was associated with significantly higher rates of pseudomeningocele (p = 0.04) and meningitis (p < 0.001). The higher rate of meningitis was influenced particularly by the higher rate of chemical meningitis (p = 0.002) versus infectious meningitis (p = 0.132). Among 4 types of nonautologous grafts, there were differences in complication rates (p = 0.02), including chemical meningitis (p = 0.01) and postoperative nausea/vomiting (p = 0.03). Allograft demonstrated the lowest complication rates overall (14.3%) and yielded significantly fewer complications compared to bovine collagen (p = 0.02) and synthetic (p = 0.003) grafts. Synthetic graft yielded higher complication rates than autograft (p = 0.01). Autograft and nonautologous graft resulted in equal improvements in syrinx size (p < 0.0001). No differences were found for postoperative changes in headaches or neck pain. CONCLUSIONS: In the largest multicenter cohort to date, complication rates for dural autograft and nonautologous graft are similar after PFDD for CM-I/SM, although nonautologous graft results in higher rates of pseudomeningocele and meningitis. Rates of meningitis differ among nonautologous graft types. Autograft and nonautologous graft are equivalent for reducing syrinx size, headaches, and neck pain.
OBJECTIVE: Posterior fossa decompression with duraplasty (PFDD) is commonly performed for Chiari I malformation (CM-I) with syringomyelia (SM). However, complication rates associated with various dural graft types are not well established. The objective of this study was to elucidate complication rates within 6 months of surgery among autograft and commonly used nonautologous grafts for pediatric patients who underwent PFDD for CM-I/SM. METHODS: The Park-Reeves Syringomyelia Research Consortium database was queried for pediatric patients who had undergone PFDD for CM-I with SM. All patients had tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and ≥ 6 months of postoperative follow-up after PFDD. Complications (e.g., pseudomeningocele, CSF leak, meningitis, and hydrocephalus) and postoperative changes in syrinx size, headaches, and neck pain were compared for autograft versus nonautologous graft. RESULTS: A total of 781 PFDD cases were analyzed (359 autograft, 422 nonautologous graft). Nonautologous grafts included bovine pericardium (n = 63), bovine collagen (n = 225), synthetic (n = 99), and human cadaveric allograft (n = 35). Autograft (103/359, 28.7%) had a similar overall complication rate compared to nonautologous graft (143/422, 33.9%) (p = 0.12). However, nonautologous graft was associated with significantly higher rates of pseudomeningocele (p = 0.04) and meningitis (p < 0.001). The higher rate of meningitis was influenced particularly by the higher rate of chemical meningitis (p = 0.002) versus infectious meningitis (p = 0.132). Among 4 types of nonautologous grafts, there were differences in complication rates (p = 0.02), including chemical meningitis (p = 0.01) and postoperative nausea/vomiting (p = 0.03). Allograft demonstrated the lowest complication rates overall (14.3%) and yielded significantly fewer complications compared to bovine collagen (p = 0.02) and synthetic (p = 0.003) grafts. Synthetic graft yielded higher complication rates than autograft (p = 0.01). Autograft and nonautologous graft resulted in equal improvements in syrinx size (p < 0.0001). No differences were found for postoperative changes in headaches or neck pain. CONCLUSIONS: In the largest multicenter cohort to date, complication rates for dural autograft and nonautologous graft are similar after PFDD for CM-I/SM, although nonautologous graft results in higher rates of pseudomeningocele and meningitis. Rates of meningitis differ among nonautologous graft types. Autograft and nonautologous graft are equivalent for reducing syrinx size, headaches, and neck pain.