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Duraplasty with autologous cervical fascia in pediatric posterior fossa tumor surgery: a single-center experience with 214 cases

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Abstract

Purpose

Posterior fossa surgeries for pediatric tumors pose challenges in achieving optimal dural repair and duraplasty is usually required. Autografts, allografts, xenografts, and synthetic substitutes can be used for duraplasty. Autologous cervical fascia can be a safe and reliable graft option for duraplasty after posterior fossa surgeries. This study aims to investigate the outcomes of duraplasty with autologous cervical fascial graft in children after posterior fossa surgery for pediatric brain tumors.

Methods

Pediatric patients with posterior fossa tumor who underwent surgery between March 2001 and August 2022 were retrospectively reviewed. Data on demographics, preoperative symptoms, diagnosis, tumor characteristics, hydrocephalus history, and postoperative complications, including cerebrospinal fluid (CSF) leakage, pseudomeningocele, and meningitis were collected. Logistic regression analysis was performed to explore risk factors for postoperative complications.

Results

Patient cohort included 214 patients. Autologous cervical fascia was used in all patients for duraplasty. Mean age was 7.9 ± 5.3 years. Fifty-seven patients (26.6%) had preoperative hydrocephalus and 14 patients (6.5%) received VPS or EVD perioperatively. Postoperative hydrocephalus was present in 31 patients (14.5%). Rates of CSF leak, pseudomeningocele, and meningitis were 4.2%, 2.8%, and 4.2% respectively. Logistic regression analysis revealed that postoperative EVD and VPS placement were the factors associated with postoperative complications.

Conclusion

Autologous cervical fascia is a safe and reliable option for duraplasty with minimal risk of postoperative complications. The straightforward surgical technique and with no additional cost for harvesting the graft renders autologous cervical fascia a favorable alternative for resource-limited countries or surgical settings.

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Data Availability

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

EVD:

External ventricular drain

VPS:

Ventriculoperitoneal shunt

CSF:

Cerebrospinal fluid

References

  1. Eser MT, Hanalioglu S, Cetiner MZ, Dinc S, Peker HO, Sorar M et al (2019) Identification of risk factors for postoperative cerebrospinal fluid leakage and comparison of two alternative dural augmentation techniques in posterior fossa and spinal surgeries. Turk Neurosurg 29(3):377–385

    PubMed  Google Scholar 

  2. Moskowitz SI, Liu J, Krishnaney AA. Postoperative complications associated with dural substitutes in suboccipital craniotomies. Neurosurgery. 2009;64(3 Suppl):ons28–33; discussion ons-4.

  3. Mammadkhanli O, Elbir C, Hanalioglu S, Canbay S (2020) Subfascial drainage and clipping technique for treatment of cerebrospinal fluid leak following spinal surgery. Neurosciences (Riyadh) 25(1):50–54

    Article  PubMed  Google Scholar 

  4. Wang B, Shi W, Zhang Y, Wang Y, Yang C, Huang T, et al (2022) Duraplasty with autologous nuchal ligament fascia to reduce postoperative complications in pediatric patients undergoing neoplasia resection with a suboccipital midline approach. J Neurosurg Pediatr 1–9

  5. Zhao Y, Chen L, Zhang J, You N, Liu Y, Yao A et al (2020) Duraplasty with cervical fascia autograft to reduce postoperative complications of posterior fossa tumor surgery with suboccipital midline approach. World Neurosurg 134:e1115–e1120

    Article  PubMed  Google Scholar 

  6. Martínez-Lage JF, Pérez-Espejo MA, Palazón JH, López Hernández F, Puerta P (2006) Autologous tissues for dural grafting in children: a report of 56 cases. Childs Nerv Syst 22(2):139–144

    Article  PubMed  Google Scholar 

  7. Lam FC, Kasper E. Augmented autologous pericranium duraplasty in 100 posterior fossa surgeries--a retrospective case series. Neurosurgery. 2012;71(2 Suppl Operative):ons302–7.

  8. Wang J, Li P, Liang B, Ding X, Gao H, Feng E (2023) The comparison of the watertight and non-watertight dural closure in supratentorial craniotomy: a single-institute 10-year experience with 698 patients. Medicine 102(37)

  9. Roth J, Benvenisti H, Constantini S (2018) Watertight dural closure in pediatric craniotomies-is it really necessary? World Neurosurg 114:e743–e746

    Article  PubMed  Google Scholar 

  10. Hale AT, Gannon SR, Zhao S et al (2019) Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection. J Neurosurg Pediatr 1–7

  11. Malliti M, Page P, Gury C et al (2004) Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure. a clinical review of 1 year. Neurosurgery 54(3):599–603

    PubMed  Google Scholar 

  12. Dlouhy BJ, Menezes AH (2018) Autologous cervical fascia duraplasty in 123 children and adults with Chiari malformation type I: surgical technique and complications. Journal of Neurosurgery: Pediatrics PED 22(3):297–305

    Google Scholar 

  13. Djordjevic Z, Milosavlijevic B (1974) Postoperative cerebrospinal fluid fistulas and their treatment. J Neurosurg Sci 18(2):109–111

    CAS  PubMed  Google Scholar 

  14. Abbe R (1895) Rubber tissue for meningeal adhesions. Trans Amer Surg Ass 13:490–491

    Google Scholar 

  15. Narotam PK, Qiao F, Nathoo N (2009) Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients. Clinical article J Neurosurg 111(2):380–386

    Article  PubMed  Google Scholar 

  16. Sabatino G, Della Pepa GM, Bianchi F, Capone G, Rigante L, Albanese A et al (2014) Autologous dural substitutes: a prospective study. Clin Neurol Neurosurg 116:20–23

    Article  PubMed  Google Scholar 

  17. Stevens EA, Powers AK, Sweasey TA, Tatter SB, Ojemann RG (2009) Simplified harvest of autologous pericranium for duraplasty in Chiari malformation Type I. Technical note J Neurosurg Spine 11(1):80–83

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Neslihan Nisa Gecici, Muhammet Enes Gurses, Ahmet Ilkay Isikay, Burcak Bilginer & Sahin Hanalioglu

  2. Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA

    Muhammet Enes Gurses

Authors
  1. Neslihan Nisa Gecici
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  2. Muhammet Enes Gurses
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  3. Ahmet Ilkay Isikay
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  4. Burcak Bilginer
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  5. Sahin Hanalioglu
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Contributions

Conceptualization: Sahin Hanalioglu, Burcak Bilginer, Ahmet Ilkay Isikay; methodology: Neslihan Nisa Gecici, Muhammet Enes Gurses; data analysis: Neslihan Nisa Gecici, Sahin Hanalioglu; writing—original draft preparation: Neslihan Nisa Gecici; writing—review and editing: Sahin Hanalioglu, Muhammet Enes Gurses; supervision: Sahin Hanalioglu, Burcak Bilginer, Ahmet Ilkay Isikay.

Corresponding author

Correspondence to Sahin Hanalioglu.

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Ethics approval

This study is approved by the ethics committee of the hospital where the research was conducted and informed consent is obtained from patients’ legal guardians.

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The authors declare no competing interests.

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Gecici, N.N., Gurses, M.E., Isikay, A. et al. Duraplasty with autologous cervical fascia in pediatric posterior fossa tumor surgery: a single-center experience with 214 cases. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06351-6

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