splitting ASAP硬脑膜分裂 课件.ppt

Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques John A. Jane, Jr., M.D. Associate Professor of Neurosurgery and Pediatrics Director of Pediatric Neurosurgery University of Virginia Health System Disclosures None Surgical Technique Bone removal: Posterior fossa decompression aka suboccipital craniectomy aka foramen magnum decompression C1 laminectomy, sometimes C2 and/or C3 Dural splitting The spinal dura only has one layer “Dural splitting” over the spine is not really splitting two layers Surgical Technique Decompression (bone removal) alone Dural splitting Use of intraoperative ultrasound Type of splitting Creation and removal of an outer layer Surgical Series 2006-2009, Age18 N=16 Posterior fossa decompression and duraplasty=8 6 syringomyelia Posterior fossa decompression alone=8 6 syringomyelia Both groups similar in terms of age, symptoms, degree of tonsillar herniation, and syringomyelia Outcomes Syringes Significantly decreased or resolved in 5 of 6 patients in each group Tonsillar regression PFD alone: 6 of 7 PFD plus duraplasty: 5 of 7 PFD with dural splitting PFD with dural splitting Complications Postoperative nausea PFD alone: 0/8 PFD with duraplasty: 5/8 Higher rate of complications associated with PFD with duraplasty Meningitis, Reoperation for CSF leak, Symptomatic pseudomeningocele Complications Original surgery: PFD with division of adhesions and continuous sutured duraplasty Complications Chemical meningitis: repeat PFD with removal of dural graft and placement of pericranial graft Pseudomeningocele with CSF leak requiring repeat closure of incision Continued pseudomeningocele treated with a ventriculoperitoneal shunt Recent reports Decompression alone procedures were shorter, had shorter hospital stays, and less pain and nausea However, PFD alone was associated with a higher incidence of symptomatic recurrence and need for dural opening (12.5% versus 3.1%) Conclusions Posterior fossa decompress