Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery

Artur Balasa,Sławomir Kujawski,Andrzej Marchel,Przemysław Kunert,Mateusz Bielecki,Tomasz Dziedzic

doi:10.1038/s41598-021-94179-4

Artur Balasa, Sławomir Kujawski + Show 4 more

Open Access

https://doi.org/10.1038/s41598-021-94179-4

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Abstract

Suboccipital decompression with duraplasty is a widely accepted method for treating patients with Chiari malformation type I. However, important details of the duraplasty technique are still controversial. This retrospective study analyzes clinical and radiological outcomes after surgery depending upon the type of graft and methods of graft fixation. Seventy consecutive decompressions with duraplasty were analyzed. Two types of grafts, nonautologous (Non-AutoG; 60.0%) and autologous (AutoG; 40.0%), and two methods of graft fixation, suturing (S; 67.1%) and gluing (G; 32.9%), were used in four different combinations: (Non-AutoG+S: 31.4%; Non-AutoG+G: 28.6%; AutoG+S: 35.7%; AutoG+G: 4.3%) according to surgeon preference. The mean follow-up was 63.4 months. According to gestalt and Chicago Chiari Outcome Scales, satisfactory results were obtained in 72.9% and 78.6% of cases, respectively, in the long term. The outcomes were not related to the kind of graft (p = 0.44), fixation method (p = 0.89) or duraplasty pattern (p = 0.32). Decreased syringomyelia was observed in 88.9% of cases, and no associations with the kind of graft (p = 0.84), fixation method (p = 1) or duraplasty pattern were found (p = 0.96). Pseudomeningocele occurred 5 times more often in the Non-AutoG group than in the AutoG group (52.4% vs. 10.7%; p < 0.05), whereas their formations were not related to the fixation method (p = 0.34). Three cases (12.0%) required reoperation with reduraplasty. Autologous and nonautologous dural grafts can be sutured or glued with similar clinical results; however, the use of nonautologous grafts is linked with a much higher risk of pseudomeningocele formation.

Highlights

Chiari malformation (CM) was described for the first time by pathologist Hans Chiari in 1891 and refers to congenital caudal displacement of the hindbrain elements through the foramen magnum
Different kinds of material are used for duraplasty, including autologous tissues such as epicranial aponeurosis or muscle fascia and nonautologous materials such as bovine collagen matrix[6,7,8]
To our knowledge, there has been no study evaluating the kind of graft used for duraplasty along with the method of its fixation

Summary

Introduction

Chiari malformation (CM) was described for the first time by pathologist Hans Chiari in 1891 and refers to congenital caudal displacement of the hindbrain elements through the foramen magnum. The treatment of choice in symptomatic cases is posterior fossa decompression, described for the first time in 1938 by Penfield[4]. This procedure has changed and improved over the years. Especially concerning the duraplasty techniques, are still the subject of d ebate[9,10,11,12]. To our knowledge, there has been no study evaluating the kind of graft used for duraplasty along with the method of its fixation. The aim of our study was to compare the long-term clinical and radiological outcomes of surgery for CM-I, together with a complication analysis, depending upon the duraplasty materials and methods of graft fixation

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