Enlargement Duralplasty With Artificial Dura Mater Versus Autologous Dura Mater For Chiari ? Malformation With Syringomyelia:A Comparative Study

ObjectiveTo comparatively analyze the surgery curative effect of application of artificial dura mater with autologous dura expand plasty for Chiari I deformity with syringomyelia,discuss what repair materials are more suitable for intraoperative application in Chiari I deformity and syringomyelia,in order to further improve the efficacy of surgery and reducepostoperative complications.MethodsA total of 83 cases of Chiari I malformation and syringomyelia admitted by Linyi people's Hospital from January 2011 to December 2016 were selected.The selected patients underwent MRI examination of the head and neck before the operation,and the lower end of the cerebellum tonsil were all lower than 5 mm under the foramen magnum.According to different repair materials,they were divided into two groups(autologous dura expanding forming group,artificial dura repair group),with 54 patients in autologous dura expanding forming group,and 29 cases in artificial dura repair group.Operation method adopted posterior fossa decompression plus cerebellar tonsil excision plus epidural expand repair,and postoperative observation indexes included:postoperative infection,subcutaneous effusion,cerebrospinal fluid leakage,fever,postoperative and long-term effects,and improvement of syringomyelia.Postoperative telephone follow-up and outpatient follow-up were conducted,and the follow-up time was 6-69 months.The cervical occipital MRI was reexamined after the operation.Results1.The temperature more than 38.5 ? days of autologous epidural group expand forming was0?10 days,the average(2.7 + 0.30)days,and that of artificial dura repair group was 0?12 days,the average(5.91 + 1.07)days,the fever days of autologous epidural expanding forming group was less than that of artificial dura repair group,the difference had statistical significance(p = 0.01).2.9 cases of CSF infection were identified,including 4 cases of autologous epidural expanding forminggroup,5 cases of artificial dura repair group,and the infection rate of CSF in autologous epidural expanding forming group was lower than that in artificial dura repair group,the difference was not statistically significant(p =0.27).3.There were 10 cases of subcutaneous effusion,including 3 cases of autologous epidural expanding forming group,7 cases of artificial dura repair group,,and the incidence of subcutaneous effusion in autologous epidural expanding forming group was lower than that in artificial dura repair group,the difference was statistically significant(p = 0.03).4.Cerebrospinal fluid leakage occurred in 4 cases,including 2 cases in the autologous epidural expand forming group,2 cases in the artificial dura repair group,and the incidence of cerebrospinal fluid leakage in the autologous epidural expanding forming group was lower than that in the artificial dura repair group,and there was no statistically significant difference(p = 0.61).5.Preliminary efficacy evaluation was performed before discharge,and of patients in autologous dural expanding forming group,31 cases were cured,21 cases were effective,2 cases were ineffective,and no case with aggravated symptoms.Of patients in artificial dura repair group,16 cases were cured,10 cases were effective,3 cases were ineffective,and no case with aggravated symptoms.the postoperative short-term effective rate of autologous dural expanding forming group was higher than that of artificial dura repair group,but there was no statistically significant difference(p =0.67).6.Long-term follow-up of patients after surgery,and 6 months after surgery to review the cervical occipital MRI,disappearance or basic disappearance of MRI cavities in the patient's syringomyelia of autologous epidural expanding forming group and artificial dura repair group were 17 cases and 9 cases respectively;The narrowing of the cavities in syringomyelia were 33 cases and 17 cases respectively in MRI.There was no change or aggravation of MRI spinal cord in 1 case and 3 cases respectively,and the difference between the two groups was not statistically significant(p=0.49).7.Long-term follow-up of patients after surgery,and evaluate the curative effect at 6 months after operation,and in autologous epidural expanding forming group,38 cases were cured,12 were effective,and 1 was ineffective.In artificial dura repair group,14 cases were cured,11 cases were effective,3 cases were ineffective 1 case aggravated.The postoperative long-term effective rate of autologous epidural expanding forming group was higher than that of artificial epidural group,the difference was statistically significant(p = 0.01).ConclusionIn Chiari I malformation with syringomyelia surgery,the artificial dura and autologous dural dilation were not different in postoperative infection,cerebrospinal fluid leakage,postoperative curative effect,and the improvement of the spinal cord cavity.The autologous dural dilation was superior to artificial dural enlargement in reducing subcutaneous effusion,fever and long-term efficacy.Therefore,autologous dura is superior to the artificial dural in the operative effect,and the autologous dura is more suitable for repairing.