Short Term Complications of Myelomeningocele Repair. An Experience in Neurosurgery Department Lady Reading Hospital Peshawar

  • M Idris Khan Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar
  • Wefaq Ullah Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar
  • Muhammad Ishfaq Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar
  • Bakht Zar Khan Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar
  • Mumtaz Ali Professor, Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar
Keywords: Ventriculoperitonial shunt, Myelomeningocele, Spinal cord, CSF leak

Abstract

Objective: To determine the short term complications of Myelomeningocele repair.
Material and Methods: This cross sectional study was conducted at Neurosurgery Department, PGMI Lady Reading Hospital, Peshawar from January 2014 to June 2014 with total 6 months duration. All patients having age from 1 to 6 months with either gender who were operated for myelomeningocele were included and those patients having MMC with a prior VP shunt, moribund patients who do not survive for 30 days were excluded from the study. Patients age, gender and short term complications of surgery were documented on pre designed proforma. Minimum one month follow up was done. Data was analyzed by SPSS version 17 and expressed in the form of tables and charts.
Results: In this study 58% children were in age range 1 – 2 months and 42% children were in age range 3 – 6 months. Mean age was 2 months with SD ± 1.26. Fifty five percent children were male and 45% children were female. VP Shunt was put in 12% children, CSF Leak was found in 15% and infection was found in 23% of cases.
Conclusion: Wound site infection and CSF leak are the most common short term complications of myelo-meningocele repair.

References

1. Singh P, Soni A, singh RJ. Double meningocele; case report and anatomic rationale. J Anatom Societ Ind. 2008; 57 (1): 43-6.
2. Idris B. Factors Affecting the Outcomes in Children Post-Myelomeningocoele Repair in Northeastern Penin-sular Malaysia. Malaysian J Med Sci. 2011; 18 (1): 52-9.
3. Chand MB, Agrawal J, Bista P. Anaesthetic Challenges and Management of Myelomeningocele Repair. Post-grad Med J NAMS. 2011; 11 (1): 41-6.
4. Adzick NS. Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Semin Fetal Neonatal Med. 2010; 15 (1): 9–14.
5. Radmanesh F, Khashab F, Nejat ME. Shunt complicat-ions in children with myelomeningocele; Effect of tim-ing of shunt placement. J Neurosurg Pediat. 2009; 3: 516-20.
6. Hashim ASM, Ahmad S, Jooma R. Management of Myelomeningocle. J Surgery Pakistan (Inter). 2008;1 3 (1): 7-11.
7. Sankhla S, Khan GM. Reducing CSF shunt placement in patients with spinal myelomeningocele. J Pediatr Neurosci. 2009; 4 (1): 20-9.
8. Ikasi. James HE, Lubinsky G. Terminal myelocysto-cele. J Neurosurg. 2005; 103: 443-5.
9. Lee SK, Gower DJ, MC Whorter JM. The role of MR imaging in the diagnosis and treatment of anterior sac-ral meningocele J Neurosurg. 1988; 69: 628-31.
10. Logan WJ. Neurological examination in infancy and childhood chapter 200 sections VII. Pediatrics, 3169-86.
11. MC Neely PD, Howe WJ. infectiveness of dietary folic acid supplementation on the incidence of lipomyelome-ningocele: pathogenic implications. J Neurosurg. 2004; 100: 98-100.
12. Sharif S, Allcutt D, Markes C. Tethered cord syndrome; recent clinical experience. Br J Neurosurg. 1997; 11: 49-51.
13. Park TS, Cail WS, Maggio WM. Progressive spasticity and scoliosis in children with myelomeningocele. Radi-ological investigation and surgical treatment. J Neuro-surg. 1985; 62: 367-75.
14. Lee SK, Gower DJ, MC Whorter JM. The role of MR imaging in the diagnosis and treatment of anterior sac-ral meningocele J Neurosurg. 1988; 69: 628-31.
15. Taskaynatan MA, Izci Y, Ozgul A, Hazneci B, Dursun H, Kalyon TA. “Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain”. Spine, 2005; 30 (8): E210–3.
16. Steinbok P, Cochrane DD. The nature of congenital posterior cervical or cervico thoracic midline cutaneous mass lesions. J Neurosurg. 1991; 75: 206-12.
17. Tamaki N, Shirataki K, Kojima N. Tethered cord synd-rome following repair of myelomeningocele. J Neuro-surg. 1988; 9: 393-8.
18. Vernet O, Farmer JP, Houle AM. Impact of urodynamic studies on the surgical management of spinal cord teth-ering. J Neurosurg. 1996; 85: 555-9.
19. Warder DE, Oakes WJ. Tethered cord syndrome and the conus in a normal position. Neurosurgery, 1993; 33: 374-8.
Published
2018-10-03
Section
Original Articles