A Clinico Demographic and Outcome Based Study of Surgical Management of Open Neural Tube Defects

Dr Anil kumar Malhari; Dr Sateesh Melkundi

Volume : IX, Issue : II, February - 2020

A Clinico Demographic and Outcome Based Study of Surgical Management of Open Neural Tube Defects

Dr Anil Kumar Malhari, Dr Sateesh Melkundi

Abstract :

Background: Myelomeningocele is the commonest paediatric neurosurgical problem encountered in clinical practice. The problem is the exposed neural tube and impaired circulation of CSF. A good surgery consists of excision of myelocele sac, repair of neural tube defect, watertight closure of the CSF leak and proper cover with durable, tension free soft tissue and skin. These are necessary to prevent infection leading to meningitis, ventriculitis and its associated complication which may end as death also. However none of these measures prevent the subsequent development of hydrocephalus. Plastic surgical assistance is needed many times in giving proper soft tissue coverage and acceptable skin closure in open neural defects. This retrospective study analyses the outcome of various surgical procedures performed for closure of Meningomyelocele defects. Material and methods: This was a prospective follow up study done on 60 NTD babies. This study was done for duration of 4 years ranging from Jul 2015 to Jun 2019 in a tertiary care center. All meningomyelocele cases were primarily treated by the Dept of Neurosurgery. Only those cases where primary closure of the skin defect was not possible were referred to the Dept of Plastic surgery. Each NTD baby was followed up for a mean of 1 year after various types of surgeries. Results: They were 4 cervical, 6 thoracic and 20 lumbar meningomyelocele cases.The duration of follow up ranged from 3 months to 2.5years with a mean follow up of 1 year. 9 children died in the immediate post OP period due to pneumoniae, sepsis and other causes unrelated to surgery.2 children were lost for follow up. 19 children remained in the study group. Of the 19 cases of the Myelomeningoceles sought for plastic surgery intervention for closure of defect after neural tube repair, 6 underwent Limberg flap, 6 underwent bilateral bipedicled flaps with skin grafts at lateral edges, 1 underwent multiple Z plasties,1 underwent horizontal bipedicled flap closure,another 5 patients underwent reverse latissimus muscle flap and skin grafting. 3 patients with bipedicled flap closure developed partial flap necrosis,which were deided, managed conservatively in 2 cases and skin grafted in 1 case. Conclusion: Large MMC need plastic surgery intervention for closure of defects after neural tube closure.Plastic surgeon has various local and regional flaps like Limberg flap,Z plasty,bipedicled facsciocutaneous flaps in his armamentarium for closure of the defects depending on the adjacent tissue laxity,shape of defect,size of defect and experience of the surgeon.