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AlloDerm for duraplasty in Chiari malformation: superior outcomes

  • Clinical Article - Neurosurgical Techniques
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Abstract

Background

Autologous pericranium, fascia lata (either as autograft or allograft), bovine pericardium (DuraGuard), fetal bovine tissue (Durepair), processed collagen matrix (DuraGen), and synthetic fabrics (e.g., synthetic Goretex graft) have all been used for duraplasty in Chiari decompression surgery, and no consensus exists as to the optimal material. We reviewed our experience to compare the incidence of graft-related complications associated with using acellular human dermis allograft (AlloDerm) with those of DuraGuard, DuraGen, and Durepair.

Methods

In a retrospective cohort chart review, our cohort included 119 patients who underwent 128 Chiari decompression procedures by a single surgeon from January 1, 1997, through July 31, 2012. Age, sex, smoking status, weight, and the type of dural graft used were analyzed with univariate statistical tests. Dural grafts were selected based on the commercial products available at the time of surgery during this 15-year period.

Results

The reoperation rate for cerebrospinal fluid leak causing pseudomeningocele was 2.2 % (1/46 cases) with the AlloDerm graft and 17.1 % (14/82 cases) with other materials (p = 0.01). Each of the non-AlloDerm grafts had a higher reoperation rate than AlloDerm when analyzed separately. Not using AlloDerm was the only statistically significant factor for the need for reoperation (p = 0.01).

Conclusions

The use of the AlloDerm dural graft for duraplasty in Chiari decompressions resulted in a significantly lower pseudomeningocele formation than the use of any other type of dural graft. There was no association between patient age, sex, extra weight, or smoking status and the need for reoperation.

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Acknowledgments

We thank Kristin Kraus, M.Sc., for editorial assistance preparing this paper.

Conflicts of interest

The authors do not report any conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Specifically, there is no relationship between the company that markets or produces AlloDerm and the authors of this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Christian A. Bowers & Richard H. Schmidt

  2. University of Utah School of Medicine, Salt Lake City, UT, USA

    Cameron Brimley

  3. Southern Utah Neurosciences Institute, St. George, UT, USA

    Chad Cole

  4. Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, USA

    Wayne Gluf

Authors
  1. Christian A. Bowers
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  2. Cameron Brimley
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  3. Chad Cole
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  4. Wayne Gluf
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  5. Richard H. Schmidt
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Corresponding author

Correspondence to Richard H. Schmidt.

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Bowers, C.A., Brimley, C., Cole, C. et al. AlloDerm for duraplasty in Chiari malformation: superior outcomes. Acta Neurochir 157, 507–511 (2015). https://doi.org/10.1007/s00701-014-2263-x

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  • DOI: https://doi.org/10.1007/s00701-014-2263-x

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