Autologous cervical fascia duraplasty in pediatric posterior fossa tumor surgery: A low-cost and viable alternative.

BACKGROUND

Pediatric tumors of the posterior fossa represent a significant challenge in neurosurgery. Various dural substitutes have been used to repair dural defects, with a wide range of success rates and associated complications. This study aims to evaluate the feasibility of autologous cervical fascia duraplasty, describe surgical technique, and report incidence rates of postoperative complications.

METHODS

A retrospective observational study included 24 pediatric patients (1-16 years) with posterior fossa tumors who underwent tumor resection with autologous cervical fascia dural closure at a tertiary hospital in Mexico between 2019 and 2024. Postoperative complications were assessed over 12 months. Tumor resection and watertight dural closure used a 5 × 5 cm fascia graft harvested from the superficial layer of the cervical fascia, with careful preservation of the underlying musculature and occipital nerve. Medical records were reviewed to collect demographic data and postoperative outcomes.

RESULTS

13 of 24 patients were male (54.2%), and 13 of 24 patients (54.2%) had preoperative hydrocephalus. No procedure-related mortality was observed. Postoperative complications included aseptic meningitis in 2 cases (8.3%) and hydrocephalus requiring VP shunt in 3 cases (12.5%). No cerebrospinal fluid (CSF) fistulas, pseudomeningoceles, or wound dehiscence were observed.

CONCLUSION

Autologous cervical fascia duraplasty is a safe and effective technique for pediatric posterior fossa tumor surgery, providing reliable watertight closure with low rate of CSF leak, pseudomeningocele, hydrocephalus, and aseptic meningitis. Its accessibility and lower cost make it a practical option in low-resource settings.