Experience of Ruptured Thoracolumbar Myelomeningocele Repair Under Local Anesthesia in Neonates

Asif Rasheed Asif; Zahid Hussain; Shahzad Ahmed Qasmi; Burhan Ul Haq; Imran Ashraf; Abdul Rehman Arshad

doi:10.51253/pafmj.v75iSUPPL-4.12079

Authors

Asif Rasheed Asif Department of Neuro Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Zahid Hussain Department of Neuro Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shahzad Ahmed Qasmi Department of Neuro Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Burhan Ul Haq Department of Neuro Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Imran Ashraf Department of Neuro Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Abdul Rehman Arshad Department of Neuro Surgery, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-4.12079

Keywords:

Myelomeningocele. Spinal dysraphism. Thoracolumbar. Hydrocephalus.

Abstract

Objective: To see the efficacy of surgical repair of ruptured thoracolumbar myelomeningocele under local anesthesia.

Study Design: Quasi experimental study.

Place and Duration of Study: Neurosurgery center, CMH Rawalpindi, Pakistan from Jun 2022 to Jan 2024.

Methodology: All the patients were operated within 24 hours of presentation to the hospital. All the patients were neonates, having ruptured Thoracolumbar Myelomeningocele sac, with established complete or incomplete neurological deficit. The cases with intact neurology, cervical and upper thoracic vertebral levels, severe or un-diagnosed coagulopathy were excluded from the study. Parents were counselled in detail about the purpose of the surgical procedure being to prevent future complications of ruptured myelomeningocele; and established neurological deficit shall not be reversed.

Results: Out of the 50 children, with male pre-ponderance, 17 were paraplegic and 33 were paraparetic. Surgical site infection, post repair hydrocephalus, cerebrospinal fluid leak and meningitis were seen in 8%, 38%, 10% and 4 % of the participants, respectively. No patients developed any local anesthesia systemic toxicity. 6% patients developed wound dehiscence resulting in re-admission. The mean hospitalization stay was 3.5±2.0 days, while mean operative time was approximately 40 minutes. Mean blood loss was 35.8±7.04 ml, while mean transfusion was 21.38±6.49ml. Mean follow-up time was 6.7±1.6 days. 2(4%) patients lost to follow-up. One patient died before discharge.

Conclusion: The repair of ruptured Thoracolumbar Myelomeningocele under local anesthesia, is an efficient, convenient, cost effective and feasible surgical approach for resource constrained settings with high patient burden.

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References

Bevan R, Wilson-Jones N, Bhatti I, Patel C, Leach P. How much do plastic surgeons add to the closure of myelomeningoceles? Child’s Nervous System [Internet]. 2017 Dec 8 [cited 2019; 34(4): 737–740.

https://doi.org/10.1007/s00381-017-3674-9

Moore KL, Persaud TVN, Torchia MG. The developing human clinically oriented embryology. eighth ed. Philadelphia Saunders Elsevier; 2008. p. 388–92.

Beuriat PA, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C. Complete Reversibility of the Chiari Type II Malformation After Postnatal Repair of Myelomeningocele. World Neurosurgery 2017; 108: 62–8.

https://doi.org/10.1016/j.wneu.2017.08.152

Radcliff E, Cassell CH, Laditka SB, Thibadeau JK, Correia J, Grosse SD et al. Factors associated with the timeliness of postnatal surgical repair of spina bifida. Childs Nerv Syst 2016; 32(8): 1479-87. https://doi.org/10.1007/s00381-016-3105-3

Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB. Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 2016; 32(4): 675-80.

https://doi.org/10.1007/s00381-016-3012-7

Hadžagić-Ćatibušić F, Maksić H, Užičanin S, Heljić S, Zubčević S, Merhemić Z, et al. Congenital Malformations of the Central Nervous System: Clinical Approach. Bosnian Journal of Basic Medical Sciences 2008; 8(4): 356–60.

https://doi.org/10.17305/bjbms.2008.2897

Frezer Mengiste, Mulugeta Sitot Shibeshi, Dagnachew Gechera. Neural Tube Defect in a Resource Limited Setting: Clinical Profile and Short Term Outcome. Pediatric Health, Medicine and Therapeutics 2023 Sep 1 [cited 2024 Jan 22]; Volume 14: 289–99. https://doi.org/10.2147/PHMT.S421868

Alruwaili AA, M Das J. Myelomeningocele [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK546696

Sharma MK, Kumar N, Jha MK, N U, Srivastava RK, Bhattacharya S et al. Experience with various reconstructive techniques for meningomyelocele defect closure in India. JPRAS Open 2019; 21: 75–85.

https://doi.org/10.1016/j.jpra.2019.07.001

Özek MM, 2008. Early Surgical Complications of Spina Bifida. In Özek MM, Cinalli G and Maixner W, 2008. The Spina Bifida: Management and Outcome. Milan: Springer.p. 177-183.

https://doi.org/10.3174/ajnr.A1300

Lorber J. Results of treatment of myelomeningocele. An analysis of 524 unselected cases, with special reference to possible selection for treatment. Dev Med Child Neurol 1971; 13(3): 279-303. https://pubmed.ncbi.nlm.nih.gov/4937369

Acosta-Medina E, Zorro-Guío OF, Abdala-Vargas NJ, Jacomussi-Alzate L, Figueredo LF, Johnson JM, et al. Postnatal Surgical Correction of Myelomeningoceles: Preoperative and Intraoperative Risk Factors Associated with Postoperative Neurologic Outcomes. World Neurosurgery 2023; 170: e629–38.

https://doi.org/10.1016/j.wneu.2022.11.079

Hagemann C, Krajewski K, Henne T, Stücker R, Kunkel P. Postnatal repair of open neural tube defects: A single center with 90-Month interdisciplinary follow-up. Journal of Clinical Medicine2021; 10. https://doi.org/10.3390/jcm10194510

Shim JH, Hwang NH, Yoon ES, Dhong ES, Kim DW, Kim SD. Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair. Archives of Plastic Surgery 2016; 43(1): 26–31.

https://doi.org/10.5999/aps.2016.43.1.26

Cherian J, Staggers KA, Pan I-Wen, Lopresti M, Jea A, Lam S. Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis. Journal of Neurosurgery: Pediatrics 2016; 18(4): 416–22. https://doi.org/10.3171/2016.1.PEDS15674

Sawyer T, Yamada N, Umoren R. The difficult neonatal airway. Seminars in Fetal and Neonatal Medicine 2023; 28(5): 101484.

https://doi.org/10.1016/j.siny.2023.101484

Sahni M, Alsaleem M, Ohri A. Meningomyelocele [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK536959

Zoghi S, Feili M, Mosayebi MA, Ansari A, Feili A, Masoudi MS, et al. Surgical outcomes of myelomeningocele repair: A 20-year experience from a single center in a middle-income country. Clinical Neurology and Neurosurgery 2024; 239: 108214. https://doi.org/10.1016/j.clineuro.2024.108214

Sawa, Teiji, et al. "Difficult Airway Management in Neonates and Infants: Knowledge of Devices and a Device-Oriented Strategy." Frontiers in Pediatrics, vol. 9, 2021, p. 654291. https://doi.org/10.3389/fped.2021.654291

Ferreira Furtado LM, Da Costa Val Filho JA, Dantas F, Moura de Sousa C. Tethered Cord Syndrome After Myelomeningocele Repair: A Literature Update. Cureus [Internet]. 12(10): e10949. https://doi.org/10.7759/cureus.10949

Reynolds RA, Bhebhe A, Garcia RM, Chen H, Bonfield CM, Lam S, et al. Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia. World Neurosurgery 2021; 145: e332–9.

https://doi.org/10.1016/j.wneu.2020.10.069