Simplified harvest of autologous pericranium for duraplasty in Chiari malformation Type I

Abstract

<jats:p>The authors describe a method of harvesting autologous pericranium for duraplasty in patients with Chiari malformation Type I (CM-I) that avoids excessive exposure or a second incision. Nonautologous dural grafts have been associated with numerous complications including hemorrhage, bacteria and virus transmission, fatal Creutzfeldt-Jakob disease transmission, foreign body reaction, systemic immune response, excessive scarring, slower healing, premature graft dissolution, and wound dehiscence. Autogenous tissues have the advantage of being nonimmunogenic, nontoxic, readily available, and inexpensive. Pericranium is a preferred substrate because it is flexible, strong, and easily sutured for a watertight closure. Current literature supports the use of autogenous pericranium for dural grafting in CM-I procedures, but has heretofore failed to provide a method of harvest that avoids the complications associated with a larger exposure or second incision. The authors offer a simple alternative technique for using local pericranium in duraplasty for CM-I or other posterior fossa abnormalities.</jats:p>

Comparison of dural grafts in Chiari decompression surgery: Review of the literature

“…A fourth study[25] comparing pericranium versus synthetic graft was identified. [14] However, it dealt with brain tumor resection in addition to Chiari decompression and was therefore excluded. A fifth study comparing autologous and nonautologous graft material was excluded because the full text was only available in Chinese (abstract in English).…”

“…The disadvantages of nonautologous dural grafts include an increased risk of hemorrhage, often with silastic grafts,[142427] bacterial and viral transmission; Creutzfeldt-Jakob disease transmission, exclusively with cadaveric graft;[1427‐36] eosinophilic-aseptic meningitis;[37] foreign body reaction and scarring;[14] increased wound healing time;[14] premature graft dissolution;[14] and wound dehiscence. [14] In the case of xenogenic pericardium, specifically bovine pericardium, the potential for bovine spongiform encephalopathy exists.…”

“…A number of graft types, both autologous and nonautologous, are available to the neurosurgeon. Dural substitutes used in Chiari I decompression surgery include autologous pericranium,[11012‐14] bovine pericardium,[12] cadaveric dura,[112] synthetic bovine collagen matrix (Duragen, Integra Neuroscience, Plainsboro, NJ),[11] acellular human dermis allograft (AlloDerm, LifeCell Corp., Branchburg, NJ),[1115] autologous fascia lata,[1216] expanded polytetrafluoroethylene (PTFE),[101718] posterior atlantooccipital membrane,[19] splenius capitis muscle flap,[20] and porcine small intestinal submucosa (Durasis, Cook Biotech, Inc., West Lafayette, IN). [21] A recent survey of pediatric neurosurgeons by the American Association of Neurological Surgeons estimated graft preferences: 32% preferred autologous pericranium, 32% preferred bovine pericardium, 17% preferred lyophilized cadaveric dura, 16% preferred synthetic products, 4% preferred ligamentum nuchae, and 3% preferred fascia lata.…”

“…[42324] The thickness and assimilation of the graft can also affect its ease of manipulation, workability, and role as a watertight sealant to prevent extradural egress of CSF and ingress of blood and contaminants. [14] We performed a critical review of the literature to elucidate the risks and benefits of different graft types and to clarify optimal treatment options.…”

Rotational Pericranial Flap for Repair of Refractory Posterior Fossa Pseudomeningocele

“…Prior studies have examined a variety of dural substitutes for use when primary dural closure is not possible [1][2][3]. Many techniques have been suggested, including use of a composite polyglactin 910 / poly-pdioxanone mesh patch [4], monolayer and bilayer collagen matrices [5][6][7][8][9], polytetrafluoroethylene [10][11][12][13], crescent durotomies for midline suboccipital craniotomies [14], and autologous pericranium [1,15]. Of these various dural substitutes, autologous pericranium is favorable due to lack of immunogenic response, low risk of infection, flexibility, and ease of use.…”