The Use of Fibrin Sealant in Chiari Malformation Type-1 Surgery; Is It Effective in Preventing the Formation of CSF Fistula?

Background: Symptomatic disease requires surgical intervention comprising of posterior fossa decompression with or without an expansile duraplasty. Until date, the optimal surgical treatment for CM-1 has not been delineated. Thus, we evaluated the results to assess the effectiveness of fibrin sealant augmentation in combination with locally harvested autologous pericranium for duraplasty in adult CM-1 decompression. Materials and Methods: We retrospectively evaluated the cases that were operated due to CM-1. The cases were divided into two groups in which fibrin sealant FS was used and not used. There were 15 patients in the first group FS group and 16 in the second group no fibrin sealant NFS group . We followed the standardized surgical technique suggested by Stevens and colleagues for CM 1 decompression. Results: Cerebrospinal fluid CSF fistula was not observed in any patient in the FS group. However, in the NFS group, two patients were reported to develop CSF fistula. Although the findings are not statistically significant, these are clinically important. Conclusion: Use of FS to seal the autologous graft during closure may prevent the occurrence of CSF fistula among patients of CM-1.

Keywords:

Arnold-Chiari malformation, Type 1, fibrin sealant autografts, cerebrospinal fluid leakage,

PDF

___

1.D Adams CB. I’ve torn it: How to repair it. Br J Neurosurg 1995; 9:201–4
2.Haines SJ, Berger M. Current treatment of Chiari malformations types I and II: a survey of the pediatric section of the American association of Neurological Surgeons. Neurosurgery 1991:28(3):353-57
3.Nash J, Cheng JS, Meyer GA, Remler BF. Chiari type I malformation: overview of diagnosis and treatment. Wisconsin Medical Journal 2002;101(8):35-40
4.Nagib MG. An approach to symptomatic children (ages 4– 14 years) with Chiari type-I malformation. Pediatr Neurosurg 1994;21(1):31-35
5.Dyste GN, Menezes AH. Presentation and management of pediatric Chiari malformations without myelodysplasia. Neurosurgery 1998;23(5):589-97
6. Krieger MD, McComb JG, Levy ML. Toward a simpler surgical management of Chiari I malformation in pediatric population. Pediatr Neurosurg 1999;30(3);113-21.
7.Zerah M. Syringomyelia in children. Neurochirurgie 1999; 1(45):37-57
8. Lazareff JA, Valencia-Myoral P. Chiari malformation. Boletín Médico del Hospital Infantil de México 1990;47 (10):719-24
9. Eule Jm, Erickson MA, O’Brien MF, Handler M. Chiari I malformation associated with syringomyelia and scoliosis: a twenty-year review of surgical and nonsurgical treatment in a pediatric population. Spine 2002;27(13): 1451-55
10.Yundt KD, Park TS, Tantuwaya VS, Kaufman BA. Posterior fossa decompression without duraplasty in infants and young children for treatment of chiari malformation and achondroplasia. Pediatric Neurosurgery 1996;25(5):221– 226
11. Isu T, Sasaki H, Takamura H, Kobayashi N. Foramen magnum decompression with removal of the outer layer of the dura as treatment for syringomyelia occurring with Chiari I malformation. Neurosurgery 1993;33(5): 844–849
12.Genitore L, Peretta P, Nurisso C, Macinante L, Mussa F. Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases. Child's Nervous System 2000;16(10-11):707–718
13.Alden TD, Ojeman JG, Park TS. Surgical treatment of Chiari malformation: indications and approaches. Neurosurgical Focus;2001;11(1):E2
14.Hankinson T, Tubbs RS, Wellons JC. Duraplasty or not? An evidence-based review of pediatric Chiari malformation. Child's Nervous System 2011; 27(1):35–40
15.Sindou M, Gimbert E. Decompression for Chiari type Imalformation (with or without syringomyelia) by extreme lateral foramen magnum opening and expansile duraplasty with arachnoid preservation: comparison with other technical modalities (Literature review). Advances and Technical Standards in Neurosurgery 2009;34:85-110
16.Manley GT, Dillon W. Acute posterior fossa syndrome following lumbar drainage for treatment of suboccipital pseudomeningocele. Report of three cases. J Neurosurg. 2000; 92:469–74
17.Summary of Safety and Effectiveness Data: Dura Seal Dural Sealant System. Silver Spring: U.S. Food and Drug Administration; 2005. Administration USFaD
18.Cosgrove GR, Delashaw JB, Grotenhuis JA, Tew JM, Van Loveren H, Spetzler RF, et al. Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair. J Neurosurg. 2007; 106:52–8
19.Than KD, Baird CJ, Olivi A. Polyethylene glycol hydrogel dural sealant may reduce incisional cerebrospinal fluid leak after posterior fossa surgery. Neurosurgery 2008 Jul;63: ONS182-6; discussion ONS186-7
20. Lam FC, Penumaka A, Chen CC, Fischer EG, Kasper EM. Fibrin sealant augmentation with autologous pericranium for duraplasty after suboccipital decompression in Chiari 1 patients: A case series. Surg Neurol Int. 2013; 4:6
21.Tonkins M, Farooqi N, Ahmed R, Sinha S, Bhattacharyya D. Closing the dura: dural hitching versus surgicel and tisseel overlay graft in craniocervical decompression for Chiari 1 malformation. Br J Neurosurg. 2017 Aug;31(4): 422-425
22. Langridge B, Phillips E, Choi D. Chiari Malformation Type 1: Systematic Review of Natural History and Conservative Management. World Neurosurg. 2017 Aug;104:213-219
23.Stevens EA, Powers AK, Sweasey TA, et al. Simplified harvest of autologous pericranium for duraplasty in Chiari malformation Type I. Technical note. J Neurosurg Spine 2009;11:80-3