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

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 de...

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Autores principales:	Artur Balasa, Przemysław Kunert, Tomasz Dziedzic, Mateusz Bielecki, Sławomir Kujawski, Andrzej Marchel
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/33df6dc4706d4ebc94274fbc82555abe
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spelling	oai:doaj.org-article:33df6dc4706d4ebc94274fbc82555abe2021-12-02T16:50:24ZComparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery10.1038/s41598-021-94179-42045-2322https://doaj.org/article/33df6dc4706d4ebc94274fbc82555abe2021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94179-4https://doaj.org/toc/2045-2322Abstract 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.Artur BalasaPrzemysław KunertTomasz DziedzicMateusz BieleckiSławomir KujawskiAndrzej MarchelNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Artur Balasa Przemysław Kunert Tomasz Dziedzic Mateusz Bielecki Sławomir Kujawski Andrzej Marchel Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery
description	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.
format	article
author	Artur Balasa Przemysław Kunert Tomasz Dziedzic Mateusz Bielecki Sławomir Kujawski Andrzej Marchel
author_facet	Artur Balasa Przemysław Kunert Tomasz Dziedzic Mateusz Bielecki Sławomir Kujawski Andrzej Marchel
author_sort	Artur Balasa
title	Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery
title_short	Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery
title_full	Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery
title_fullStr	Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery
title_full_unstemmed	Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery
title_sort	comparison of dural grafts and methods of graft fixation in chiari malformation type i decompression surgery
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/33df6dc4706d4ebc94274fbc82555abe
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Comparison of dural grafts and methods of graft fixation in Chiari malformation type I decompression surgery

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