title: Comparison of dural grafts in Chiari decompression surgery: Review of the literature.
abstract: BACKGROUND
  Decompression of Chiari malformation is a common procedure in both pediatric and adult neurosurgery. Although the necessity for some bony removal is universally accepted, other aspects of Chiari surgery are the subject of debate. The most controversial points include the optimal amount of bony removal, the use of duraplasty (and the type of material), the need for subarachnoid dissection, and the need for tonsillar shrinkage.
  
  
  METHODS
  We critically reviewed the literature to elucidate the risks and benefits of different graft types and to clarify optimal treatment options therein. Based on our search results, 108 relevant articles were identified. With specific inclusion and exclusion criteria, we noted three studies that directly compared two tlpes of dural substitutes in Chiari malformation surgery.
  
  
  RESULTS
  Our review did not support the superiority of either autologous or nonautologous grafts when duraplasty is employed. Our institutional experience, however, dictates that when the pericranium is available and of good quality, it should be utilized for duraplasty. It is non-immunogenic, inexpensive, and capable of creating a watertight closure with the dura.
  
  
  CONCLUSIONS
  Discrepancies between the three comparative studies analyzed are likely attributable to increases in pericranial quality and thickness with maturity. Future randomized studies with large numbers and the power to resolve differences in the relatively low rates of complications in Chiari surgery are warranted.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.forename: Timothy
authors.initials: T
authors.lastname: Link
authors.forename: David
authors.initials: D
authors.lastname: Fusco
authors.forename: David A
authors.initials: DA
authors.lastname: Wilson
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag