Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients

Clinical article

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Object

Complete dural closure is not always possible following posterior fossa surgery, often requiring a graft to secure complete closure. The authors report their experience of using a collagen matrix as an onlay dural graft for repair of a posterior fossa dural defect.

Methods

A retrospective analysis was performed in 52 adult patients who had undergone collagen matrix duraplasty for the posterior fossa. Complications directly related to the dural graft, the presence or absence of hydrocephalus, and the role of closed suction wound drainage in relation to postsurgical pseudomeningoceles were analyzed.

Results

The indication for posterior fossa surgery was tumors in 32 patients, vascular abnormalities in 9 patients, and spontaneous cerebellar hemorrhage in 11 patients. Closed suction wound drainage was used in 23 patients (44.2%). Forty-eight (92.3%) of 52 patients had a dural defect > 2 cm. Nine (81.8%) of 11 patients with hydrocephalus required ventriculoperitoneal shunts. Complications of the surgery included pseudomeningoceles in 2 patients (3.8%; no closed suction wound drainage); superficial wound infections in 1 patient (1.9%; with closed suction wound drainage); and unexplained eosinophilia in 1 patient.

Conclusions

Duraplasty using a collagen matrix is safe and effective in the posterior fossa, and is easy to use and time efficient. Meticulous layered wound closure, the detection and effective control of hydrocephalus, and the use of closed suction wound drainage reduces complications related to collagen matrix duraplasty for the posterior fossa.

Abbreviation used in this paper: VPS = ventriculoperitoneal shunt.

Article Information

Address correspondence to: Pradeep K. Narotam, M.D., 1530 North 7th Street, #106, Terre Haute, Indiana 47807. email: narotam@mac.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Illustrations showing the relationship of collagen matrix duraplasty, bone flap, and closed suction wound drainage. A: Shaped collagen matrix used as an onlay dural graft. B: Closed suction wound drainage over bone flap. C: Sagittal view showing the relationship of collagen matrix duraplasty and closed suction wound drainage. Illustrations by Spencer Rippen, Creighton University.

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    Illustration of the collagen matrix and its interaction with the dura. The collagen matrix provides a chemical signal for fibroblast infiltration that becomes established after 10–14 days. The fibroblasts use the pores in the collagen matrix as a scaffold to lay down new collagen. Over the next 6–8 weeks, the collagen matrix is resorbed as the new dura in constituted. Illustration by Spencer Rippen, Creighton University.

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