Dural sealants are commonly used in posterior fossa decompression with duraplasty (PFDD) for Chiari malformation type I (CMI). Prior evidence suggests that combining certain sealants with some graft material is associated with an increased rate of complications. In 2018, the authors noted an increased rate of symptomatic pseudomeningocele and aseptic meningitis after PFDD in CMI patients. The authors utilized retrospective and prospective analyses to test the hypothesis that complication rates increase with the use or combination of certain sealants and grafts.

The analysis was split into 2 periods. The authors retrospectively reviewed patients who underwent PFDD for CMI at their center between August 12, 2011, and December 31, 2018. The authors then eliminated use of DuraSeal on the basis of the retrospective analysis and prospectively examined complication rates from January 1, 2019, to August 4, 2021. The authors defined a complication as symptomatic pseudomeningocele, bacterial or aseptic meningitis, cerebrospinal fluid leak, subdural hygroma, hydrocephalus, surgical site infection, or wound dehiscence.

From 2011 to 2018, complications occurred in 24.5% of 110 patients. Sealant choice was correlated with complication rates: no sealant (0%), Tisseel (6%), and DuraSeal (15.3%) (p < 0.001). No difference in complication rate was noted on the basis of choice of graft material (p = 0.844). After eliminating DuraSeal, the authors followed 40 patients who underwent PFDD after 2018. The complication rate decreased to 12.5%. All complications after 2018 were associated with Tisseel.

At the authors’ single center, use of sealants in PFDD surgery for CMI, especially DuraSeal, was correlated with a higher complication rate. Eliminating DuraSeal led to a significant decrease in the rate of symptomatic pseudomeningocele and aseptic meningitis.

硬脑膜密封剂常用于 I 型 Chiari 畸形 (CMI) 的后颅窝减压联合硬膜成形术 (PFDD)。先前的证据表明，将某些密封剂与某些移植材料结合使用会增加并发症的发生率。2018 年，作者注意到 CMI 患者 PFDD 后症状性假性脑脊膜膨出和无菌性脑膜炎的发生率增加。作者利用回顾性和前瞻性分析来检验并发症发生率随着某些密封剂和移植物的使用或组合而增加的假设。

分析分为 2 个阶段。作者回顾性地回顾了 2011 年 8 月 12 日至 2018 年 12 月 31 日期间在其中心接受 PFDD 治疗 CMI 的患者。然后作者根据回顾性分析取消了 DuraSeal 的使用，并从 2019 年 1 月 1 日起前瞻性检查了并发症发生率，至 2021 年 8 月 4 日。作者将并发症定义为有症状的假性脑脊膜膨出、细菌性或无菌性脑膜炎、脑脊液漏、硬膜下积液、脑积水、手术部位感染或伤口裂开。

从 2011 年到 2018 年，110 名患者中有 24.5% 出现并发症。密封剂选择与并发症发生率相关：无密封剂 (0%)、Tisseel (6%) 和 DuraSeal (15.3%) (p < 0.001)。根据移植材料的选择，并发症发生率没有差异（p = 0.844）。去除 DuraSeal 后，作者追踪了 2018 年之后接受 PFDD 的 40 名患者，并发症发生率降至 12.5%。2018 年之后的所有并发症都与 Tisseel 相关。

在作者的单一中心，在 CMI 的 PFDD 手术中使用密封剂，尤其是 DuraSeal，与更高的并发症发生率相关。消除 DuraSeal 可显着降低有症状的假性脑膜膨出和无菌性脑膜炎的发生率。