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Duraplasty Type as a Predictor of Meningitis and Shunting After Chiari I Decompression
Harrison Farber1, Michael M McDowell2, Ahmad Alhourani2
1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Background:
Expansile duraplasty is frequently performed during Chiari I decompression. Aseptic and bacterial meningitis are possible complications of this procedure. We sought to compare the rates of meningitis and subsequent need for cerebrospinal fluid (CSF) diversion with duraplasty using bovine pericardial (BPC) xenograft and allograft.
Methods:
We conducted a retrospective review of 112 patients who underwent Chiari I decompression. All patients underwent duraplasty with either allograft or BPC. Occurrence of postoperative lumbar punctures and associated data were recorded to determine rates of meningitis. Rates of subsequent shunting were also recorded.
Results:
Overall, 112 patients were included in the study: 30 underwent duraplasty with allograft (27%) and 82 received BPC (73%). A total of 26 patients developed postoperative meningitis (23 cases of chemical meningitis and 3 of bacterial meningitis). Rates of meningitis were higher in patients who received BPC than patients who received allograft (28% vs. 10%, respectively; P = 0.047). The rate of shunting was greater in patients with meningitis compared with patients without meningitis (56.5% vs. 5.75%, respectively; P < 0.0001). Moreover, 13 of the 15 patients (87%) in the BPC cohort who were shunted were found to have meningitis compared with 0 of the 3 shunted patients (0%) in the allograft cohort (P = 0.044).
Conclusions:
We found that rates of total meningitis were greater in patients who underwent Chiari I decompression and duraplasty with BPC compared with an allograft. The rate of shunting was significantly higher for patients who developed meningitis after decompression compared with patients without meningitis.
Insights
Bovine pericardial (BPC) xenografts for duraplasty during Chiari I decompression are linked to higher meningitis rates and increased need for cerebrospinal fluid (CSF) shunting compared to allografts.
Area of Science:
- Neurosurgery
- Surgical Complications
- Biomaterials in Surgery
Background:
- Expansile duraplasty is a common procedure for Chiari I decompression.
- Meningitis is a potential complication following duraplasty.
- Comparing bovine pericardial (BPC) xenografts with allografts for duraplasty is crucial for understanding complication rates.
Purpose of the Study:
- To compare the incidence of meningitis after Chiari I decompression using BPC xenograft versus allograft for duraplasty.
- To evaluate the subsequent requirement for cerebrospinal fluid (CSF) diversion in patients experiencing meningitis.
Main Methods:
- Retrospective review of 112 patients undergoing Chiari I decompression with either allograft or BPC duraplasty.
- Analysis of postoperative lumbar punctures and associated data to determine meningitis rates.
- Recording of rates for subsequent CSF shunting procedures.
Main Results:
- Meningitis occurred in 28% of patients receiving BPC duraplasty versus 10% receiving allograft (P=0.047).
- Patients with meningitis had a significantly higher rate of shunting (56.5%) compared to those without (5.75%) (P<0.0001).
- 87% of shunted patients in the BPC group had meningitis, compared to 0% in the allograft group (P=0.044).
Conclusions:
- Duraplasty with BPC xenografts for Chiari I decompression is associated with higher rates of meningitis than allografts.
- Meningitis following Chiari I decompression significantly increases the likelihood of requiring CSF shunting.
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