Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis

Abstract

BACKGROUND Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results. OBJECTIVE To compare outcomes between pericranial autograft and AlloDerm (BioHorizons). METHODS Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement. RESULTS A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr (11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71). CONCLUSION In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.

Dual Dural Patch Graft With AlloDerm and DuraGen Underlay for Duraplasty in Chiari Malformation Results in Significantly Decreased Cerebrospinal Fluid Leak Complications

“…Some authors advocate using autologous pericranium, citing potentially lower cost and enhanced watertight closure; however, studies have yielded mixed results regarding overall outcomes. 8,10,11,[15][16][17][18][19] Danish et al 12 found that autologous tissue bore similar pseudomeningocele and CSF leak rates to AlloDerm. Attenello et al 11 reported better syrinx improvement after synthetic vs pericranium duraplasty (80.0% vs 52.0%) and fewer CSF leaks (0% vs 5%).…”

Outcome of Posterior Fossa Decompression with Duraplasty by Different Types of Graft in Patients with Chiari Malformation Type I

“…Duraplasty may be performed using a variety of dural grafts, including autologous pericranium, allografts, xenografts, and synthetic substitutes. It is yet unknown if any of these materials are related with greater rates of CSF leakage or other adverse effects 6 . Our rational was assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients who managed by posterior fossa decompression and duraplasty.…”

Commentary: Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis

“…1 Postoperative cerebrospinal fluid (CSF) leak occurred in 9 patients (9%), 8 of whom were in the AlloDerm group, and obesity was associated with 5-fold increase in the odds of CSF leak. 1 In addition, pseudomeningocele was observed in 11 patients (13%) out of 81, for whom a follow-up magnetic resonance imaging (MRI) was available without association with the graft type. 1 Although the current literature reporting the outcomes for different dural grafts is somewhat conflicting and of low quality, a recent meta-analysis encompassing 1461 patients and assessing the outcomes for various dural graft materials found that autograft was associated with the lowest rate of postoperative complications compared to nonautologous graft materials, collagen-based graft, and allograft.…”

“…1 In addition, pseudomeningocele was observed in 11 patients (13%) out of 81, for whom a follow-up magnetic resonance imaging (MRI) was available without association with the graft type. 1 Although the current literature reporting the outcomes for different dural grafts is somewhat conflicting and of low quality, a recent meta-analysis encompassing 1461 patients and assessing the outcomes for various dural graft materials found that autograft was associated with the lowest rate of postoperative complications compared to nonautologous graft materials, collagen-based graft, and allograft. 2 My experience corroborates the results of this meta-analysis and supports the data of the present study on the efficacy of autologous duraplasty with pericranium in reducing postoperative CSF leak.…”

“…7 Interestingly, the authors reported a high rate of arachnoid dissection (85%) and tonsillar reduction (65%). 1 The issue of intradural pathology in association with Chiari malformation is another topic that continues to be under discussion. Several authors described the existence of intradural findings such as arachnoid veils or web and arachnoid adhesions in patients with Chiari malformation with and without syringomyelia.…”