Introduction: Chiari malformation type 1 (CM1) is characterized by the downward displacement of the cerebellar tonsils, potentially compressing the brainstem or obstructing cerebrospinal fluid (CSF) flow. Post-operative pseudomeningocele formation is a recognized complication, yet the impact of duraplasty materials and techniques, particularly in the pediatric population, is understudied. This study aims to evaluate pseudomeningocele formation relative to duraplasty techniques, dural graft type, and use of dural sealant in the pediatric population.
Methods: We conducted a retrospective, single-institution review of pediatric patients ( < 18 years) at a high-volume pediatric center undergoing surgery for CM1 between 2010 to 2023. Demographic, clinical, radiographic, and surgical data were analyzed. Univariate (Chi-squared and Fisher) analysis was performed to identify significant predictors of pseudomeningocele formation, followed by multivariate (logistic regression) analysis.
Results: Of 164 patients (80 male, 84 female) who underwent duraplasty, 28 (17%) developed pseudomeningocele. No pseudomeningoceles were symptomatic. No patients developed a CSF leak post-operatively. 88 (54%) patients had Y-shaped dural incision and 76 (46%) had linear dural incision. Univariate analysis revealed that Y-shaped incisions were associated with a higher rate of pseudomeningocele formation (19 vs. 9 patients), trending towards significance (p=0.148). Biosynthetic dural grafts were more likely to lead to pseudomeningocele development than autografts (p=0.019). Evicel and Vistaseal, both fibrin-based sealants, showed different outcomes; 25.3% of patients treated with Evicel developed a pseudomeningocele, compared to 6.1% with Vistaseal (p = 0.008). Multivariate analysis indicated no individual variable significantly predicted pseudomeningocele formation, but a significant intercept suggested collinearity between dural graft and sealant types, indicating unaccounted variables influencing outcomes.
Conclusion : While our results suggest possible correlation of dural graft type and fibrin-based sealant with asymptomatic pseudomeningocele formation, more variables across a larger population is needed to better understand potential cofounders and unstudied independent variables.
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