Surgical timing and treatment modalities for developing hydrocephalus in newborns with spinal dysraphism
Abstract
Introduction:
Spinal dysraphism includes spinal anomalies caused by defective neural tube fusion, leading to significant morbidity, especially in developing countries. These conditions require urgent and lifelong medical care. Surgery plays a vital role in treatment and helps prevent complications. This study evaluates the impact of surgical timing and techniques on complications, supported by a literature review.
Methods:
This retrospective study included 102 spinal dysraphism patients treated between 2007 and 2010 at İzmir Tepecik Training and Research Hospital. Patient records were analyzed for gestational age, birth weight, gender, maternal age, folic acid use, lesion location, neurological findings, comorbidities, imaging results, surgical procedures, timing, and complications.
Findings: 55% of the cases in the study (n=102) were male. In 42% of all cases, the lesion was in the thoracolumbar region and hydrocephalus was detected in 45% (n=56). 34.3% of the cases were operated within the first 6 hours. The rate of neurological deficits was significantly higher in cases where the operation was performed after 6 hours (p=0.026). Again, meningitis infection was detected as high in cases operated after 6 hours (p=0.005). There was no significant difference in the risk of developing meningitis in cases operated before and after the 3rd day (p=0.07). There was no significant difference between the cases with and without shunt placement in terms of infection frequency, risk of CSF fistula, and probability of developing neurological deficit (p=1.00, p=0.74, p=0.098, respectively).
Conclusion: Early surgical planning is necessary to minimize post-surgical complications in newborns with spinal dysraphism. Early surgical application will also reduce the possibility of late neurological deficits.
References
- Brand MC. Examining the newborn with an open spinal dysraphism. Adv Neonatal Care 2006 Aug;6(4):181-96
- Lynam L, Verklan MT. Neurologic disorders. In: Verklan MT, Walden M, eds. Core Curriculum for Neonatal Intensive Care. 3rd ed. St. Louis, Mo: Elsevier Saunders;2004:821– 857.
- Boran BO, Kızılçay G, Bozbuğa M. Ventriküloperitoneal şant disfobksiyonu. Türk Nöroşir Derg 2005; 15:148-151.
- Akalan N: Spinal açık ve kapalı orta hat birleşim anomalileri. Aksoy K (ed). Temel Nöroşirurji. Türk Nöroşirürji Yayınları, Ankara:2005, s.1335-1346.
- Dias MS: Myelomeningocele in Pediatric Neurosurgery. Edited by M.Choux, C. Dİ Rocco, A.D.Hockley, M.L.Walker, Churchill Livingstone, London 1999,pp.33-60. İPTAALLLL
- Miller PD, Pollack IF, Pang D, Albright AL: Comparison of Simultaneous versus delayed ventriculoperitoneal şant insertion in children undergoing myelomeningocele repair. J Child Neurol 1996;11:370-372.
- Talamonti G, D’Aliberti G, Collice M: Myelomeningocele: Longterm neurosurgical treatment and follow up in 202 patients. J Neurosurg 107(5 Suppl): 368-386, 2007.
- Arslan M, Eseoglu M, Gudu BO, Demir I, Kozan A, Gokalp A, Sosuncu E, Kiymaz N: Comparison of simultaneous şanting to delayed şanting in infants with myelomeningocele in terms of şant infection rate. Turk Neurosurg 3:397-402, 2011.
- Padmanabhan R:Etiology, pathogenesis and prevention of neural tube defects. J Cong Anomal 2006;46:555-567.
- Oktem IS, Menku A, Ozdemir A: When should ventriculoperitoneal şant placement be performed in cases with myelomeningocele and hydrocephalus? Turk Neurosurg 4:387-391, 2008.
- Arslan M, Eseoglu M, Gudu BO, Demir I, Kozan A, Gokalp A, Sosuncu E, Kiymaz N: Comparison of simultaneous şanting to delayed şanting in infants with myelomeningocele in terms of şant infection rate. Turk Neurosurg 3:397-402, 2011.
- Charney EB, Melchionni JB, Antonucci DL. Ventriculitis in newborns with myelomeningocele. Am J Dis Child. 1991 Mar;145(3):287-90.
- Fernandez-Serrats AA, Guthkelch AN, Parker SA (1967) The prognosis of open myelocele with a note on a trial of Laurence’s operation. Dev Med Child Neurol (Suppl 13):65–74.
- Sheu BB, Ameh EA, Ismail. NJ. Spina Bifida Cystica:Selective managemnet in Zaria,Nigeria. Ann Trop Paediatr 2000;20:239-242.
- Siedel SB, Gardner PM, Howard PS. Soft- tissue coverage of the neural elements after myelomeningocele repair. Ann Plast Surg 1996;37:310-316.
- Attenello FJ, Tuchman A, Christian EA, Wen T, Chang KE, Nallapa S, Cen SY, Mack WJ, Krieger MD, McComb JG. Infection rate correlated with time to repair of open neural tube defects (myelomeningoceles): an institutional and national study. Childs Nerv Syst. 2016 Sep;32(9):1675-81.
- Oncel MY , Ozdemir R, Kahilogulları G. Et al. The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele. J Korean Neurosurg Soc. 2012 Jun;51(6):359-62.
- Brau RH, Rodriguez R, Ramirez MV, Gonzalez R, Martinez V: Experience in the management of myelomeningocele in Puerto Rico. J Neurosurg 1990;72:726-731.
- Charney EB, Weller SC, Sutton LN, Bruce DA, Schut LB. Management of the newborn with myelomeningocele: time for a decision-making process. Pediatrics. 1985 Jan;75(1):58-64. PMID: 2578222.
- Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA (2001) Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34 (3):114–120.
- Thompson DNP. Postnatal management and outcome for neural tube defects including Spina Bifida and encephaloceles. Prenat Diagn 2009; 29: 412-419.
- Mwang’ombe NJ, Omulo T (2000) Ventriculoperitoneal şant surgery and şant infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. East Afr Med J 77(7):386–390.
- Margaron FC, Poenaru D, Bransford R, Albright AL. Timing of ventriculoperitoneal şant insertion following spina bifida closure in Kenya. Childs Nerv Syst. 2010 Nov;26(11):1523-8.
- Tuli S, Drake J, Lamberti-Pasculli M: Long term outcome of hydrocephalus management in myelomeningocele. Childs Nerv Syst 19:286-291, 2003.
- İştemen İ, Arslan A, Olguner SK, Açik V, Ökten Aİ, Babaoğlan M. Şant timing in meningomyelocele and clinical results: analysis of 80 cases. Childs Nerv Syst. 2021 Jan;37(1):107-113.
- White MD, McDowell MM, Agarwal N, Greene S. Şant infection and malfunction in patients with myelomeningocele. J Neurosurg Pediatr. 2021 Feb 26;27(5):518-524.
- Cherian J, Staggers KA, Pan IW, Lopresti M, Jea A, Lam S. Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis. J Neurosurg Pediatr. 2016 Oct;18(4):416-422.
Abstract
Amaç: Spinal disrafizm, embriyonik nöral tüpün kusurlu orta hat füzyonundan kaynaklanan çeşitli omurga anomalilerini kapsamaktadır. Gelişmekte olan ülkelerdeki bu anomaliler, acil ve ömür boyu tıbbi bakım gerektiren birçok morbiditeye sahiptir. Tedavide cerrahi önemli bir yer tutmakta ve gelişebilecek komplikasyonları önlemede etkili olmaktadır. Çalışmamızın amacı; spinal disrafizm cerrahisindeki zamanlamanın ve cerrahi olarak uygulanan yöntemlerin, gelişebilecek komplikasyonlar üzerindeki etkisini ortaya koymak ve gelişen komplikasyonları literatür eşliğinde tartışmaktır.
Gereç ve Yöntem: Bu çalışmaya, Sağlık Bakanlığı İzmir Tepecik Eğitim ve Araştırma Hastanesi Nöroşirürji Kliniği ile Çocuk Yenidoğan kliniğinde, 2007- 2010 yılları arasında spinal disrafizm tanısı alan 102 hasta dahil edildi. Dosyalar retrospektif olarak incelenerek, doğum haftası, kilosu, cinsiyeti, anne yaşı ve folik asit kullanım öyküleri, lezyonun lokalizasyonu, nörolojik muayenesi, ek hastalık varlığı, BT ve MR raporları, uygulanan cerrahi müdahale ve zamanlama, komplikasyonlar kaydedildi.
Bulgular: Çalışmadaki olguların (n=102) %55’i erkekti. Tüm olguların %42’sinde lezyon torako-lomber bölgedeydi ve %45’nde (n=56) hidrosefali saptandı. Olguların %34,3’ü ilk 6 saatte opere edildi. Operasyonu 6 saatten sonra yapılan olgularda anlamlı olarak nörolojik defisit oranı yüksek çıktı (p=0.026). Yine 6 saatten sonra opere edilen olgularda menenjit enfeksiyonu anlamı olarak yüksek saptandı (p=0.005). 3. Günde önce ve sonra opere edilen olgularda menenjit gelişme riski açısından anlamı farklılık saptanmadı (p=0.07). Primer defekt onarımı ile beraber şant takılan ve takılmayan olgular arasında enfeksiyon sıklığı, BOS fistülü riski, nörolojik defisit gelişme olasılığı açısından anlamlı bir farklılık saptanmadı (sırasıyla, p=1.00, p=0.74, p=0.098).
Sonuç: Spinal disrafizm olan yenidoğanlarda cerrahi sonrası komplikasyonları en aza indirmek için erken zamanda cerrahi planlama gereklidir. Erken cerrahi uygulama ileri dönem nörolojik defisit olasılığını da azaltacaktır.
References
- Brand MC. Examining the newborn with an open spinal dysraphism. Adv Neonatal Care 2006 Aug;6(4):181-96
- Lynam L, Verklan MT. Neurologic disorders. In: Verklan MT, Walden M, eds. Core Curriculum for Neonatal Intensive Care. 3rd ed. St. Louis, Mo: Elsevier Saunders;2004:821– 857.
- Boran BO, Kızılçay G, Bozbuğa M. Ventriküloperitoneal şant disfobksiyonu. Türk Nöroşir Derg 2005; 15:148-151.
- Akalan N: Spinal açık ve kapalı orta hat birleşim anomalileri. Aksoy K (ed). Temel Nöroşirurji. Türk Nöroşirürji Yayınları, Ankara:2005, s.1335-1346.
- Dias MS: Myelomeningocele in Pediatric Neurosurgery. Edited by M.Choux, C. Dİ Rocco, A.D.Hockley, M.L.Walker, Churchill Livingstone, London 1999,pp.33-60. İPTAALLLL
- Miller PD, Pollack IF, Pang D, Albright AL: Comparison of Simultaneous versus delayed ventriculoperitoneal şant insertion in children undergoing myelomeningocele repair. J Child Neurol 1996;11:370-372.
- Talamonti G, D’Aliberti G, Collice M: Myelomeningocele: Longterm neurosurgical treatment and follow up in 202 patients. J Neurosurg 107(5 Suppl): 368-386, 2007.
- Arslan M, Eseoglu M, Gudu BO, Demir I, Kozan A, Gokalp A, Sosuncu E, Kiymaz N: Comparison of simultaneous şanting to delayed şanting in infants with myelomeningocele in terms of şant infection rate. Turk Neurosurg 3:397-402, 2011.
- Padmanabhan R:Etiology, pathogenesis and prevention of neural tube defects. J Cong Anomal 2006;46:555-567.
- Oktem IS, Menku A, Ozdemir A: When should ventriculoperitoneal şant placement be performed in cases with myelomeningocele and hydrocephalus? Turk Neurosurg 4:387-391, 2008.
- Arslan M, Eseoglu M, Gudu BO, Demir I, Kozan A, Gokalp A, Sosuncu E, Kiymaz N: Comparison of simultaneous şanting to delayed şanting in infants with myelomeningocele in terms of şant infection rate. Turk Neurosurg 3:397-402, 2011.
- Charney EB, Melchionni JB, Antonucci DL. Ventriculitis in newborns with myelomeningocele. Am J Dis Child. 1991 Mar;145(3):287-90.
- Fernandez-Serrats AA, Guthkelch AN, Parker SA (1967) The prognosis of open myelocele with a note on a trial of Laurence’s operation. Dev Med Child Neurol (Suppl 13):65–74.
- Sheu BB, Ameh EA, Ismail. NJ. Spina Bifida Cystica:Selective managemnet in Zaria,Nigeria. Ann Trop Paediatr 2000;20:239-242.
- Siedel SB, Gardner PM, Howard PS. Soft- tissue coverage of the neural elements after myelomeningocele repair. Ann Plast Surg 1996;37:310-316.
- Attenello FJ, Tuchman A, Christian EA, Wen T, Chang KE, Nallapa S, Cen SY, Mack WJ, Krieger MD, McComb JG. Infection rate correlated with time to repair of open neural tube defects (myelomeningoceles): an institutional and national study. Childs Nerv Syst. 2016 Sep;32(9):1675-81.
- Oncel MY , Ozdemir R, Kahilogulları G. Et al. The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele. J Korean Neurosurg Soc. 2012 Jun;51(6):359-62.
- Brau RH, Rodriguez R, Ramirez MV, Gonzalez R, Martinez V: Experience in the management of myelomeningocele in Puerto Rico. J Neurosurg 1990;72:726-731.
- Charney EB, Weller SC, Sutton LN, Bruce DA, Schut LB. Management of the newborn with myelomeningocele: time for a decision-making process. Pediatrics. 1985 Jan;75(1):58-64. PMID: 2578222.
- Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA (2001) Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34 (3):114–120.
- Thompson DNP. Postnatal management and outcome for neural tube defects including Spina Bifida and encephaloceles. Prenat Diagn 2009; 29: 412-419.
- Mwang’ombe NJ, Omulo T (2000) Ventriculoperitoneal şant surgery and şant infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. East Afr Med J 77(7):386–390.
- Margaron FC, Poenaru D, Bransford R, Albright AL. Timing of ventriculoperitoneal şant insertion following spina bifida closure in Kenya. Childs Nerv Syst. 2010 Nov;26(11):1523-8.
- Tuli S, Drake J, Lamberti-Pasculli M: Long term outcome of hydrocephalus management in myelomeningocele. Childs Nerv Syst 19:286-291, 2003.
- İştemen İ, Arslan A, Olguner SK, Açik V, Ökten Aİ, Babaoğlan M. Şant timing in meningomyelocele and clinical results: analysis of 80 cases. Childs Nerv Syst. 2021 Jan;37(1):107-113.
- White MD, McDowell MM, Agarwal N, Greene S. Şant infection and malfunction in patients with myelomeningocele. J Neurosurg Pediatr. 2021 Feb 26;27(5):518-524.
- Cherian J, Staggers KA, Pan IW, Lopresti M, Jea A, Lam S. Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis. J Neurosurg Pediatr. 2016 Oct;18(4):416-422.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Brain and Nerve Surgery (Neurosurgery) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 10, 2025 |
| Submission Date | February 28, 2025 |
| Acceptance Date | April 7, 2025 |
| Published in Issue | Year 2025Volume: 64 Issue: 2 |
