Clinical observations of duraplasty using synthetic dural substitute or autologous fascia lata for treating Chiari I malformation complicated with syringomyelia / 中国微创外科杂志

ABSTRACT

Objective To evaluate the curative effects and complications of synthetic dural substitute (Neuro-Patch) in the surgical treatment of Chiari type I malformation (CMI) complicated with syringomyelia (SM). Methods .Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute (Neuro-Patch Group, n=20) or autologous fascia lata (Autologous Group, n= 20). Results .Symptoms were improved in 17 patients in both of groups (85.0%) at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro-Patch Group (60.0%) and 9 patients in the Autologous Group (45.0%), without significant differences (?2=0.902,P=0.342). No statistically significant differences were observed between the Neuro-Patch Group and the Autologous Group in the operating time (3.6?0.7 h vs. 3.4?0.4 h; t=1.109,P=0.274), the time to the onset of postoperative pyrexia (7.3?3.4 d vs. 9.4?2.5 d;t=-1.560,P=0.135), the length of duration of postoperative pyrexia (range, 1~19 d vs. 1~8 d, median, 4.5 d vs. 2 d;z=-1.643,P=0.100), the drainage time (1.3?0.5 d vs. 1.2?0.4 d; t=0.230, P=0.820), the drainage volume (range, 15~300 ml vs. 20~250 ml, median, 80 ml vs. 37.5 ml; z=-1.359,P=0.174), the duration of antibiotic administration (15.8?4.8 d vs. 13.7?1.5 d;t=1.260,P=0.223), and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro-Patch Group (12.8?4.1 d) than in the Autologous Group (7.8?3.1 d) (t=3.055, P=0.007). On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow-up checkups for 9 months ~ 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologous Group, which was cured by debridement. Conclusions .The Neuro-Patch is a reliable dural substitute for repairing of dural defects in the treatment of CMI associated with syringomyelia.