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Rapid closure technique in suboccipital decompression.

Martin Vychopen1, Alexis Hadjiathanasiou2, Simon Brandecker2

  • 1Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. martin.vychopen@ukbonn.com.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|September 25, 2021
PubMed
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Fibrin sealant patch (FSP) offers a faster and safer method for suboccipital decompression compared to traditional dural reconstruction (DR). This technique significantly reduces operative time without increasing complication rates in patients with posterior fossa pathologies.

Area of Science:

  • Neurosurgery
  • Surgical Techniques
  • Critical Care

Background:

  • Suboccipital decompression is a standard procedure for managing increased intracranial pressure due to posterior fossa mass-effect lesions.
  • Various dural closure techniques exist, aiming for safe and effective decompression.
  • Comparing fibrin sealant patch (FSP) and traditional dural reconstruction (DR) is crucial for optimizing surgical outcomes.

Purpose of the Study:

  • To compare the efficacy and safety of fibrin sealant patch (FSP) versus dural reconstruction (DR) in suboccipital decompression.
  • To evaluate differences in complications, operative time, functional outcomes, and shunt necessity between the two techniques.

Main Methods:

  • Retrospective analysis of 87 patients undergoing suboccipital decompression for spontaneous intracerebellar hemorrhage, cerebellar infarction, or acute traumatic subdural hematoma (2010-2019).
Keywords:
DecompressionRapid closureSuboccipital

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  • Patients were divided into two groups based on dural closure technique: fibrin sealant patch (FSP) or dural reconstruction (DR) with a dural patch.
  • Outcomes assessed included complications (CSF leakage, hydrocephalus), operative time, revision rates, functional outcome, and VP shunt requirement.

    • Main Results:

    • No significant differences were observed in postoperative cerebrospinal fluid leakage or chronic hydrocephalus between the FSP and DR groups (p=0.47).
    • The fibrin sealant patch (FSP) group demonstrated significantly lower revision rates (2.27% vs. 16.27%, p<0.023) compared to the dural reconstruction (DR) group.
    • Operative time was substantially reduced in the FSP group (90.3 min) compared to the DR group (199.0 min) (p<0.0001).

    Conclusions:

    • Rapid closure using fibrin sealant patch (FSP) is a feasible and safe technique for suboccipital decompression.
    • The FSP technique significantly reduces operative time without compromising safety or increasing complication rates.
    • Fibrin sealant patch (FSP) represents an advantageous alternative for dural closure in suboccipital decompression procedures.