Duraplasty with autologous nuchal ligament fascia to reduce postoperative complications in pediatric patients undergoing neoplasia resection with a suboccipital midline approach

Bao WangDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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Wei ShiDepartment of Neurosurgery, PLA 960th Hospital, JiNan, ShanDong Province; and

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Yu ZhangDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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Yue WangDepartment of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi Province, China

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Chen YangDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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Tao HuangDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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Qi-long TianDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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Yan QuDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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Ju-lei WangDepartment of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province;

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OBJECTIVE

The authors sought to explore the safety and efficacy of an autologous nuchal ligament for dural repair in pediatric patients undergoing tumor resection through a suboccipital midline approach.

METHODS

Pediatric patients diagnosed with posterior fossa neoplasia who underwent surgery through a suboccipital midline approach were retrospectively reviewed. The patients were divided into artificial graft and autograft groups according to whether artificial duraplasty material or autologous nuchal ligament was used to repair the dura. Postoperative complications were reviewed and analyzed, including CSF leak, pseudomeningocele, and meningitis, during hospitalization and follow-up. Univariate and multivariate logistic regression analyses were used to investigate the relationship between duraplasty material and postoperative complications, as well as other risk factors for postoperative complications. Furthermore, multinomial logistic regression analysis was used to clarify which postoperative complications the autologous nuchal ligament tended to reduce.

RESULTS

This retrospective study included 66 pediatric patients who underwent tumor resection through a suboccipital midline approach. The clinical baseline characteristics were comparable between the two groups. The results showed that the autograft group had significantly fewer postoperative complications, especially pseudomeningocele, compared with the artificial graft group. Moreover, the time required to repair the dura in the autograft group was significantly less than that in the artificial graft group. Further results revealed that the duraplasty material, ependymoma, preoperative severe hydrocephalus requiring an external ventricular drain (EVD), and postoperative hydrocephalus exacerbation were independent risk factors for postoperative complications. In particular, the autologous fascia of the nuchal ligament tended to reduce pseudomeningocele more than CSF leak and meningitis. However, compared with pseudomeningocele and CSF leak, both ependymoma and postoperative hydrocephalus exacerbation were more likely to increase the occurrence of meningitis. In contrast, preoperative severe hydrocephalus requiring EVD led to increased rates of postoperative complications.

CONCLUSIONS

For pediatric patients with intracranial tumors who need to undergo resection through a suboccipital midline approach, dural repair using the nuchal ligament is safe, cost-effective, and time saving and significantly reduces postoperative complications.

ABBREVIATIONS

EVD = external ventricular drain; VPS = ventriculoperitoneal shunt.
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Illustration from Wang et al. (pp 538–546). © Ju-lei Wang, published with permission.

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