The authors sought to explore the safety and efficacy of an autologous nuchal ligament for dural repair in pediatric patients undergoing tumor resection through a suboccipital midline approach.

Pediatric patients diagnosed with posterior fossa neoplasia who underwent surgery through a suboccipital midline approach were retrospectively reviewed. The patients were divided into artificial graft and autograft groups according to whether artificial duraplasty material or autologous nuchal ligament was used to repair the dura. Postoperative complications were reviewed and analyzed, including CSF leak, pseudomeningocele, and meningitis, during hospitalization and follow-up. Univariate and multivariate logistic regression analyses were used to investigate the relationship between duraplasty material and postoperative complications, as well as other risk factors for postoperative complications. Furthermore, multinomial logistic regression analysis was used to clarify which postoperative complications the autologous nuchal ligament tended to reduce.

This retrospective study included 66 pediatric patients who underwent tumor resection through a suboccipital midline approach. The clinical baseline characteristics were comparable between the two groups. The results showed that the autograft group had significantly fewer postoperative complications, especially pseudomeningocele, compared with the artificial graft group. Moreover, the time required to repair the dura in the autograft group was significantly less than that in the artificial graft group. Further results revealed that the duraplasty material, ependymoma, preoperative severe hydrocephalus requiring an external ventricular drain (EVD), and postoperative hydrocephalus exacerbation were independent risk factors for postoperative complications. In particular, the autologous fascia of the nuchal ligament tended to reduce pseudomeningocele more than CSF leak and meningitis. However, compared with pseudomeningocele and CSF leak, both ependymoma and postoperative hydrocephalus exacerbation were more likely to increase the occurrence of meningitis. In contrast, preoperative severe hydrocephalus requiring EVD led to increased rates of postoperative complications.

For pediatric patients with intracranial tumors who need to undergo resection through a suboccipital midline approach, dural repair using the nuchal ligament is safe, cost-effective, and time saving and significantly reduces postoperative complications.

作者试图探索自体颈韧带用于通过枕下中线入路进行肿瘤切除的儿科患者硬脑膜修复的安全性和有效性。

回顾性分析了通过枕下中线入路接受手术的诊断为后颅窝肿瘤的儿科患者。根据是否使用人工硬膜成形材料或自体颈韧带修复硬脑膜，将患者分为人工移植和自体移植组。对住院和随访期间的术后并发症进行回顾和分析，包括脑脊液漏、假性脑脊膜膨出和脑膜炎。采用单因素和多因素logistic回归分析，探讨硬膜成形材料与术后并发症的关系，以及术后并发症的其他危险因素。此外，

这项回顾性研究包括 66 名通过枕下中线入路接受肿瘤切除的儿科患者。两组的临床基线特征具有可比性。结果表明，与人工移植组相比，自体移植组术后并发症，尤其是假性脑脊膜膨出明显减少。此外，自体移植组修复硬脑膜所需的时间明显少于人工移植组。进一步的结果表明，硬脑膜成形材料、室管膜瘤、术前需要外部脑室引流（EVD）的严重脑积水和术后脑积水加重是术后并发症的独立危险因素。尤其是，颈韧带自体筋膜比脑脊液漏和脑膜炎更容易减少假性脑膜膨出。然而，与假性脑膜膨出和脑脊液漏相比，室管膜瘤和术后脑积水加重更容易增加脑膜炎的发生。相比之下，需要 EVD 的术前严重脑积水导致术后并发症发生率增加。

对于需要通过枕下中线入路进行切除的颅内肿瘤儿科患者，使用颈韧带进行硬脑膜修复是安全的、具有成本效益的、节省时间的，并且可以显着减少术后并发症。