Article
Advantages of U-shape dural opening in posterior fossa surgery in pediatric patients
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Authors
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Rousinelle Da Silva Freitas
- Bereich Pädiatrische Neurochirurgie, Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Cahit Kural
- Bereich Pädiatrische Neurochirurgie, Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Maria Laura Laffitte
- Bereich Pädiatrische Neurochirurgie, Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Martin Schuhmann
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Bereich Pädiatrische Neurochirurgie, Tübingen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Midline suboccipital approach is the standard approach for many posterior fossa pathologies. Y-shaped dural incision is the classical technique for dura opening, however duraplasty is necessary for watertight closure in the majority of cases. U-shaped durotomy is an alternative technique with several advantages. The aim of this study was to analyze the results of U-shaped durotomy in pediatric cases with median suboccipital approach.
Methods: 50 children underwent surgical treatment in the posterior fossa using U-shaped durotomy . 50% of cases had pilocytic astrocytoma, 25% medulloblastoma, 25% other (tumor) pathologies. We recorded extend of exposure, necessity of dural retraction sutures, percentage of primary dura closure versus duraplasty, and rate of postoperative CSF leaks , infections and revisions.
Results: U-shaped durotomy was easily applied in all cases. Intradural venous sinuses, if present in infants and small children, could all be addressed in a controlled manner without significant blood loss. No additional lateral dural retraction was necessary for full exposure, also for lateralized pathologies. The dura was closed by primary suture in 50/50 tumor cases, no duraplasty was performed. In the postoperative period, no CSF fistula or pseudomeningocele and no infection were observed, in one case a superficial wound revision because of skin dehiscence was necessary.
Conclusion: U-shaped dural opening can be easily applied in all pediatric posterior fossa lesions. Midline as well as lateral located lesions can be resected without additional dural retraction or cut. U-shaped durotomy in this series had a 0% rate of duraplasty for closure and 0% rate of CSF fistula and infections. Since Y shape technique has beed abandoned in our service 8 years ago, a control group does not exist. Compared to literature reports on Y shape opening. which all describe a significant rate of duraplasty, CSF leaks, pseudomeningocele and infections, U shape opening seems to be the superior technique and can be recommended without restrictions.
