title: Technical nuances of autologous pericranium harvesting for dural closure in Chiari malformation surgery.
abstract: Duraplasty is a step commonly used for the treatment of Chiari I malformation after foramen magnum decompression. A variety of dural substitutes are currently available for dural closure to minimize the complications related to cerebrospinal fluid (CSF). We describe a technique of harvesting occipital pericranium for duraplasty associated with preservation of a wide cuff of muscle at the superior nuchal line that allows anatomical muscle closure at the end of the procedure. Five symptomatic patients with Chiari I malformation and one patient with syringomyelia-Chiari I complex were operated on with this technique. The indications to perform a duraplasty were accidental arachnoid breaching in three patients during an extra-arachnoidal approach and arachnoidal dissection due to intraoperative findings of arachnoid pathology in the remaining three patients. The overall morbidity of this technique was nil. In all patients the postoperative magnetic resonance imaging scan demonstrated significant expansion of the cisterna magna with no evidence of pseudomeningocele. Duraplasty with autologous pericranium and standardized closure of soft tissues seem promising in reducing the CSF-related complications during Chiari surgery.
authors.affiliation: Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Perrini
keywords: Chiari I malformation; dural closure; duraplasty; morbidity; pericranial graft
references.citation: Neurosurgery. 2012 Dec;71(2 Suppl Operative):ons302-7
references.pmid: 22843136
references.citation: Acta Neurochir (Wien). 1996;138(7):788-801
references.pmid: 8869706
references.citation: J Neurosurg. 1998 Jul;89(1):155-6
references.pmid: 9647189
references.citation: Neurosurgery. 2000 Jun;46(6):1384-9; discussion 1389-90
references.pmid: 10834643
references.citation: Childs Nerv Syst. 1995 Nov;11(11):625-9
references.pmid: 8608577
references.citation: Neurosurgery. 2008 Mar;62(3 Suppl 1):156-60; discussion 160-1
references.pmid: 18424981
references.citation: Neurosurgery. 2012 Aug;71(2):365-80; discussion 380
references.pmid: 22569058
references.citation: J Neurosurg. 2002 Sep;97(2 Suppl):266-8
references.pmid: 12296691
references.citation: Neurosurg Rev. 2008 Jul;31(3):331-5
references.pmid: 18311492
references.citation: Acta Neurochir (Wien). 1999;141(9):949-60; discussion 960-1
references.pmid: 10526076
references.citation: J Craniovertebr Junction Spine. 2010 Jan;1(1):29-37
references.pmid: 20890412
references.citation: Acta Neurochir (Wien). 2007 Oct;149(10):1015-22; discussion 1022-3
references.pmid: 17712512
references.citation: J Neurosurg Spine. 2009 Jul;11(1):80-3
references.pmid: 19569946