Dural augmentation approaches and complication rates after posterior fossa decompression for Chiari I malformation and syringomyelia: a Park-Reeves Syringomyelia Research Consortium study

Abstract

OBJECTIVEPosterior 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.METHODSThe 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.RESULTSA 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.CONCLUSIONSIn 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.

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

“…After a duraplasty with pericranium, Attenello et al 17 found a greater incidence of CSF leakage. A recent multi-center research conducted by Yahanda et al 18 found that autografts and nonautologous grafts had a similar overall complication rate (p=0.12), with greater incidence of pseudomeningocele (p=0.04) associated with the use of the nonautologous graft which was similar to our results. A recent study by Elkatatny et al 13 observed CSF leakage in 6.6% in fascia lata graft.…”

Association between synthetic sealants and increased complication rates in posterior fossa decompression with duraplasty for Chiari malformations regardless of graft type

“…A similar result was shown by Yahanda et al, who used data from the Park-Reeves Syringomyelia Research Consortium in a retrospective review of 781 pediatric patients who underwent PFDD for CMI with syringomyelia. 24 They found a significant difference in the complication rates among the 4 nonautologous grafts included in their analysis, with the second highest rate reported for bovine collagen (34.7%) and the lowest for allograft (14.3%). In contrast to the study by Yahanda et al, we did not find a significant difference in the complication rates between grafts, potentially be-cause our study was underpowered compared with their large-cohort study.…”

“…On January 1, 2020, all our surgeons also stopped using Durepair as a graft because of the publication of the Park-Reeves Syringomyelia Research Consortium study data. 24 Any additional onlay grafting material, which included autologous muscle to re-enforce any site of CSF leak after duraplasty, Gelfoam (Pfizer), and DuraGen matrix (Integra LifeSciences Corp.), was also recorded and included in the analysis.…”

The RAPID Consortium: A Platform for Clinical and Translational Pituitary Tumor Research

“…1,2 . There has been continued interest in establishing surgical registries in neurosurgery, with some of the best examples in spine 3,4 , pediatric hydrocephalus 5 , radiosurgery 6 , neurovascular surgery 7 , syringomyelia and Chiari I malformations 8 , and more recently, tumor 4 research. One group evaluating a variety of topics is comprised of neurosurgical trainees 9 .…”

“…3,4 A multicenter registry to study intraoperative magnetic resonance imaging (MRI) in neuro-oncology also uses industry funding. 8,[19][20][21][22] The National Institutes of Health has a track record of funding registries, but the focus tends to be on disease pathophysiology and epidemiology with limited room for surgical outcomes. Ultimately, the path for funding will be defined by the goals, timeline, and stakeholders of the consortium.…”