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Double collagen matrix grafting for dural closure in microvascular decompression: an alternative use of autologous fascial grafting

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

Watertight dural closure is a crucial step in preventing postoperative cerebrospinal fluid (CSF) leak and subsequent infection in posterior fossa surgery. The aim of this study is to assess an alternative use of collagen matrix double grafting in microvascular decompression (MVD).

Methods

Dural closure using double collagen matrix grafts was retrospectively compared with autologous fascial grafting in 120 patients who underwent MVD. Double collagen matrix grafting technique, a combination use of inlay and onlay grafting (DuraGen®, Integra Lifesciences, Plainsboro, NJ, USA, $700–800 for an MVD craniotomy size), was applied in 60 patients (the collagen matrix group). In the remaining 60 patients, an autologous fascial graft was sutured in a watertight fashion to the dural defect (the fascia group). Postoperative wound complications, such as CSF leak and infection, were retrospectively compared between the two groups.

Results

CSF leaks were observed in 3 patients (5.0%) in the fascia group and in 2 patients (3.3%) in the collagen matrix group. All cases of CSF leakage presented with pseudomeningoceles except one patient who developed an incisional CSF leak. A repair surgery for CSF leak was required in this one patient in the fascia group. Subcutaneous abscesses were noted in 2 patients (3.3%) in the fascia group. There was no patient who developed a subcutaneous abscess in the collagen matrix group. One patient in each group developed aseptic meningitis. Statistical analyses revealed that the collagen matrix group showed non-inferior outcomes to the fascia group in CSF leaks and infectious complications.

Conclusions

Double grafting technique with a combination of inlay and onlay collagen sheets is a safe and secure alternative for watertight dural closure despite a cost limitation.

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References

  1. Aihara N, Yamada H, Takahashi M, Inagaki A, Murakami S, Mase M (2017) Postoperative headache after undergoing acoustic neuroma surgery via the retrosigmoid approach. Neurol Med Chir (Tokyo) 57:634–640

    Article  Google Scholar 

  2. Altaf I, Vohra AH, Shams S (2016) Management of cerebrospinal fluid leak following posterior cranial fossa surgery. Pak J Med Sci 32:1439–1443

    PubMed  PubMed Central  Google Scholar 

  3. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg 82:201–210

    Article  Google Scholar 

  4. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083

    Article  Google Scholar 

  5. Bayazit YA, Celenk F, Duzlu M, Goksu N (2009) Management of cerebrospinal fluid leak following retrosigmoid posterior cranial fossa surgery. ORL J Otorhinolaryngol Relat Spec 71:329–333

    Article  Google Scholar 

  6. Dubey A, Sung WS, Shaya M, Patwardhan R, Willis B, Smith D, Nanda A (2009) Complications of posterior cranial fossa surgery - an institutional experience of 500 patients. Surg Neurol 72:369–375

    Article  Google Scholar 

  7. Ducic I, Felder JM 3rd, Endara M (2012) Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia. Headache 52:1136–1145

    Article  Google Scholar 

  8. Kinaci A, Algra A, Heuts S, O’Donnell D, van der Zwan A, van Doormaal T (2018) Effectiveness of dural sealants in prevention of cerebrospinal fluid leakage after craniotomy: a systematic review. World Neurosurg 118:368–376

    Article  Google Scholar 

  9. Kshettry VR, Lobo B, Lim J, Sade B, Oya S, Lee JH (2016) Evaluation of non-watertight dural reconstruction with collagen matrix onlay graft in posterior fossa surgery. J Korean Neurosurg Soc 59:52–57

    Article  CAS  Google Scholar 

  10. Lee YM, Ordaz A, Durcanova B, Viner JA, Theodosopoulos PV, Aghi MK, McDermott MW (2020) Cerebrospinal fluid leaks and pseudomeningocele after posterior fossa surgery: effect of an autospray dural sealant. Cureus 31:e8379

    Google Scholar 

  11. Linskey ME, Ratanatharathorn V, Peñagaricano J (2008) A prospective cohort study of microvascular decompression and gamma knife surgery in patients with trigeminal neuralgia. J Neurosurg 109:160–172

    Article  Google Scholar 

  12. Litvack ZN, West GA, Delashaw JB, Burchiel KJ, Anderson VC (2009) Dural augmentation: part I-evaluation of collagen matrix allografts for dural defect after craniotomy. Neurosurgery 65:890–897

    Article  Google Scholar 

  13. Narotam PK, van Dellen JR, Bhoola KD (1995) A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurg 82:406–412

    Article  CAS  Google Scholar 

  14. Narotam PK, Reddy K, Fewer D, Qiao F, Nathoo N (2007) Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study. J Neurosurg 106:45–51

    Article  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. J Neurosurg 111:380–386

    Article  Google Scholar 

  16. Park JS, Kong DS, Lee JA, Park K (2007) Intraoperative management to prevent cerebrospinal fluid leakage after microvascular decompression: dural closure with a “plugging muscle” method. Neurosurg Rev 30:139–142

    Article  Google Scholar 

  17. Sade B, Oya S, Lee JH (2010) Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. Clinical article J Neurosurg 114:714–718

    Article  Google Scholar 

  18. Samii M, Günther T, Iaconetta G, Muehling M, Vorkapic P, Samii A (2002) Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients. Neurosurgery 50:712–719

    Article  Google Scholar 

  19. Steinbok P, Singhal A, Mills J, Cochrane DD, Price AV (2007) Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis. Childs Nerv Syst 23:171–174

    Article  CAS  Google Scholar 

  20. Stoker MA, Forbes JA, Hanif R, Cooper C, Nian H, Konrad PE, Neimat JS (2012) Decreased rate of CSF leakage associated with complete reconstruction of suboccipital cranial defects. J Neurol Surg B Skull Base 73:281–286

    Article  Google Scholar 

  21. Than KD, Baird CJ, Olivi A (2008) Polyethylene glycol hydrogel dural sealant may reduce incisional cerebrospinal fluid leak after posterior fossa surgery. Neurosurgery 63:ONS182–6; discussion ONS186–7

  22. Venable GT, Roberts ML, Lee RP, Michael LM 2nd (2018) Primary dural closure for retrosigmoid approaches. J Neurol Surg B Skull Bas 79:330–334

    Article  Google Scholar 

  23. Zhao Y, Chen L, Zhang J, You N, Liu Y, Yao A, Zhao K, Zhang J, Xu B (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  Google Scholar 

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Acknowledgements

We thank Ms. Lori Radcliffe for assistance with English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan

    Takuro Inoue, Satoshi Shitara & Ayako Shima

  2. Department of Neurosurgery, Saiseikai Shiga Hospital, Shiga, Japan

    Yukihiro Goto

  3. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Takanori Fukushima

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  1. Takuro Inoue
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  2. Satoshi Shitara
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  4. Yukihiro Goto
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Correspondence to Takuro Inoue.

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This article is part of the Topical Collection on Functional Neurosurgery - Pain

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Inoue, T., Shitara, S., Shima, A. et al. Double collagen matrix grafting for dural closure in microvascular decompression: an alternative use of autologous fascial grafting. Acta Neurochir 163, 2395–2401 (2021). https://doi.org/10.1007/s00701-021-04856-6

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  • DOI: https://doi.org/10.1007/s00701-021-04856-6

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