Autologous tissues for dural grafting in children: a report of 56 cases.

Background: Diverse materials have been used for dural closure, including grafts of cadaveric origin. Some 168 cases of Creutzfeldt-Jakob disease have been reported following the implant of human dura mater. A few publications have addressed the use of dural grafts in children, but none has analyzed the feasibility of autologous tissues for this purpose.

Aim: Since 1994, the authors have utilized autologous tissues for dural grafting in children undergoing neurosurgical procedures, aimed at studying the feasibility of its use in this age group.

Material And Methods: We studied 56 children submitted to neurosurgical procedures who underwent an implant of a patch of autologous tissue for dural closure. Epidemiological, clinical, and neuroimaging data were processed using statistical methods.

Results: The study group was composed of 29 boys and 27 girls, with ages ranging from 1 month to 17 years (mean 7.6 years). The procedures corresponded to lesions at the posterior cranial fossa (n = 41), supratentorial cranial compartment (n = 12), and spine (n = 3). Seventy-five percent of the children had no complication. Four patients had adverse effects unrelated to dural grafting, while ten children had complications that might be associated with it. The most frequent complication was pseudomeningocele (n = 6), followed by infection (n = 3) and CSF leak (n = 1). Although hydrocephalus seemed to have an influence on the occurrence of complications, their incidence in patients without hydrocephalus did not differ statistically.

Conclusions: Autologous grafts of fascia or pericranium can be safely used for dural reconstruction in children. Given the reported complications associated with the use of foreign materials for duraplasty, the authors recommend the use of autologous tissues for dural repair, reserving other types of dural grafts for cases in which its usage is unavoidable.