Iatrogenic Cerebral Amyloid Angiopathy in Patients Treated With Cadaveric Dura Mater During Childhood Neurosurgery: A Retrospective Cohort Study.

Background: Iatrogenic cerebral amyloid angiopathy (iCAA) is a recently identified clinico-neuroradiological syndrome associated with medical procedures, particularly neurosurgical treatments involving cadaveric dura mater (e.g., Lyodura). iCAA can manifest as intracerebral hemorrhages, focal seizures, and cognitive impairment, with the risk following exposure currently unknown. We aim to evaluate the risk of developing iCAA in patients who underwent childhood neurosurgical treatment with Lyodura compared to those who did not.

Methods: This retrospective cohort study analyzed hospital records from the Christian-Doppler University Hospital in Salzburg, along with mortality data provided by the Austrian Federal Institute of Statistics (Statistik Austria). The study included all patients aged 0-18 who underwent neurosurgical procedures between January 1970 and January 1996. The primary endpoint was the diagnosis of iCAA and iCAA-related death.

Results: Of 569 pediatric neurosurgical patients, 388 (68%) were further analyzed. Four patients (1%) were diagnosed with probable iCAA at a median age of 42 years (IQR 40-47), with a median latency from surgery to symptom onset of 38 years (IQR 36-41). Only Lyodura recipients developed iCAA, with an incidence rate of 12% (OR 56, 95% CI: 6-2667). The overall incidence of symptomatic iCAA among recipients of any dura material was 5% (OR 19, 95% CI: 2-903).

Conclusions: Cadaveric dura mater, especially Lyodura, poses a long-term risk for developing iCAA. Further research is needed to determine susceptibility factors in Lyodura-exposed individuals.