• Kyung Hwan Kim, Bumsoo Park, Hyoung Soo Byoun, Jeongwook Lim, Hyon-Jo Kwon, Seung-Won Choi, Hyeon-Song Koh, Jin-Young Youm, and Seon-Hwan Kim.
• Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
• World Neurosurg. 2020 Sep 1; 141: e383-e388.

BackgroundConsidering that primary watertight dural closure is not always possible following posterior fossa surgery, several methods of dural reconstruction were proposed to reduce the risk of cerebrospinal fluid (CSF) leakage. This study aimed to evaluate the efficacy of collagen matrix inlay graft compared with other techniques in a propensity score-matched cohort.MethodsBetween 2000 and 2019, 176 consecutive patients who underwent posterior fossa surgery were enrolled. Of these, 103 patients underwent dural reconstruction with collagen matrix inlay graft (inlay group). After propensity score matching, 67 pairs were derived. The primary outcome was the development of CSF leakage. Pseudomeningocele and surgical site infection were also investigated.ResultsMedian follow-up period was 53.9 months. None of the patients in the inlay group had CSF leakage; however, leakage was evident in 5 patients (6.8%) who underwent dural reconstruction without a collagen matrix inlay graft (no-inlay group; P = 0.011). Pseudomeningocele was noted in 1 (1.4%) patient in the no-inlay group, while surgical site infection was noted in 3 (3.0%) patients in the inlay group and 4 (5.5%) patients in the no-inlay group. None of the surgical site infections were related to the use of the inlay graft. After propensity score matching, CSF leakage was still prevalent in the no-inlay group (P = 0.042).ConclusionsDural reconstruction using a collagen matrix inlay graft efficiently reduces CSF leakage after posterior fossa surgery and does not increase the risk of postoperative infection and inflammation. It seems to be a feasible option for dural reconstruction.Copyright © 2020 Elsevier Inc. All rights reserved.

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