Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

Abstract

ObjectiveMany surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction.MethodsWe conducted a retrospective review of operations performed by the senior author from 2004–2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications.ResultsIncisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05).ConclusionWhen primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

Bone Sandwich Closure Technique for Posterior Fossa Craniectomy

“…As most patients are bed bound for prolonged time during postoperative period, posterior fossa bears the brunt of increased CSF pressure due to such recumbent position. 1,7,15 Other risk factors for increased risk of CSF hydrodynamic complications in posterior fossa surgery include large size of tumors especially those greater than 3cm. 16 These factors were not found to be significant by Bayazit et al, 17 though increased blood in the field causes blockade of arachnoid villi with resultant increased CSF pressure which induces leak.…”

Liquorrhea after removal of fourth ventricle tumors in children. Retrospective analysis of a series of 211 primary surgeries

“…В детской нейрохирургической практике к пациентам с повышенным риском послеоперационной ликвореи традиционно относят все операции на ЗЧЯ [4,11,12]. Среди методов, снижающих риск ликвореи, в литературе рассматриваются различные модификации хирургической техники и добавление к шву ТМО герметизирующих препаратов и материалов [5,6,11,13,14].…”

Epidural blood patch for treatment of a large suboccipital pseudomeningocele

“…Further, PMC development in posterior fossa surgery is theorized to be multifactorial and may be driven not only by surgical technique; but also patient factors, increasing age, hydrocephalus, large adjacent CSF cisterns, the effects of gravity causing dural strain in the recumbent position and increased subcutaneous dead space after striping attachments from the occipital bone. [1][2][3][4][5]9 Despite the frequency of PMC complication there is no consensus for treatment and little advancement in terms of optimal management and the timing for intervention for PMCs. 2,6 Traditionally, conservative management is trialed and management proceeds to operative intervention in the form of CSF diversion procedures or revision surgery in patients with non-resolution of the PMC.…”

“…4 Posterior fossa surgery has a higher incidence of PMC complication compared to supratentorial surgery. 5 The development of a clinically relevant or symptomatic posterior fossa PMC is reported to range from 4-23% of cases in the literature. 5 Treatment usually follows a conservative approach initially, then progresses to trial of CSF diversion procedures, followed by surgical revision when conservative treatment has failed or if active CSF leak is present.…”

“…5 The development of a clinically relevant or symptomatic posterior fossa PMC is reported to range from 4-23% of cases in the literature. 5 Treatment usually follows a conservative approach initially, then progresses to trial of CSF diversion procedures, followed by surgical revision when conservative treatment has failed or if active CSF leak is present. 6 Re-operation can be cumbersome, requires a general anaesthetic and carries perioperative risks for the patient.…”