medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2017, Number 2

<< Back Next >>

Acta Med 2017; 15 (2)

Advantages of mielomeningocele repair and ventricular-peritoneal shunt in one surgical time: 47 cases experience

Alcocer MJL, Morales MR, Domínguez CLG

Language: Spanish
References: 32
Page: 105-111
PDF size: 153.74 Kb.


ABSTRACT

Background: Myelomeningocele is a congenital neural tube defect compatible with life, an early treatment improves functional outcome and quality of life of patients. Hydrocephalus is the main complication, requiring insertion of a ventriculoperitoneal shunt. Objective: To compare these procedures in the same operative setting (group A) versus classic repair in a fi rst time and ventriculoperitoneal shunt deferred to a second time (group B). Material and methods: Of 47 patients with myelomeningocele, 15 received simultaneous surgery. Results: Demographic data like: age, gender, body weight, lesion location and hydrocephalus degrees showed no statistically signifi cant differences. Anesthetics time (p = 0.00001), surgical time (p = 0.001) as well blood loss(p = 0.003) and hospital stay (p = 0.01); were lower in the group A, ventriculitis was the most frequent complication in both groups. No deaths occurred within 30 days in either group. Conclusions: In this series the early simultaneous performance of myelomeningocele repair and ventricularperitoneal shunt shows benefi ts in all aspects.


REFERENCES

  1. Saadai P, Farmer DL. Fetal surgery for myelomeningocele. Clin Perinatol. 2012; 39: 279-288.

  2. Valdés HJ, Canún SS, Reyes PA, Navarrete HE. Mortalidad por defectos en el cierre del tubo neural en menores de 5 años de edad en México de 1998 a 2006. Salud Pública Méx. 2010; 52: 341-349.

  3. Medina SA, Coutiño LB, Alvarado JG, Ramírez RJ. Epidemiología del mielomeningocele en niños menores de un año de edad en el Instituto Nacional de Pediatría. Rev Mex Med Phis Rehab. 2001; 13: 50-54.

  4. Kshettry VR, Kelly ML, Rosenbaum BP, Seicean A, Hwang L, Weil RJ. Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988-2010. J Neurosurg Pediatr. 2014;13:666- 678.

  5. Adzick NS. Fetal surgery for spina bifida: past, present, future. Semin Pediatr Surg. 2013; 22:10-17.

  6. Tamburrini G, Frassanito P, Iakovaki K, Pignotti F et al. Myelomeningocele: the management of the associated hydrocephalus. Childs Nerv Syst. 2013; 29:1569-1579.

  7. Longoni M, Porcel J, Gerbaudo S. Mielomeningocele: epidemiología y relación con otras complicaciones neurológicas. Rev Col Med Fis Rehab. 2012;22: 117-122.

  8. Marreiros H, Loff C, Calado E. Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review. J Spinal Cord Med. 2015;38:626-640.

  9. Davis BE, Daley CM, Shurtleff DB, Duguay S, Seidel K, Loeser JD et al. Long-term survival of individuals with myelomeningocele. Pediatr Neurosurg. 2005; 41: 186-191.

  10. Chern JJ, Muhleman M, Tubbs RS, Miller JH, Johnston JM, Wellons JC 3rd et al. Clinical evaluation and surveillance imaging in children with spina bifida aperta and shunt-treated hydrocephalus. J Neurosurg Pediatr. 2012; 9: 621-626.

  11. Hirose S, Farmer DL. Fetal surgery for myelomeningocele. Clin Perinatol. 2009; 36: 431-438.

  12. Pedreira DA, Zanon N, Nishikuni K, Moreira de Sá RA, Acacio GL, Chmait RH et al. Endoscopic surgery for the antenatal treatment of myelomeningocele: the cecam trial. Am J Obstet Gynecol. 2016; 214; 111 e1-111.e11.

  13. Grynfeltt J. La hernie lombaire. Montpellier Med. 1866; 16: 329.

  14. Lesshaft P. Die Lumbalgegend in Anat. Chirurgischer Hinsicht. Arch. f. Anat. u. Physiol. u. Wissensch. Med. Leipzig. 1870; 37: 264.

  15. Beuriat PA, Szathmari A, Grassiot B, Plaisant F, Rousselle C, Mottolese C et al. Role of endoscopic third ventriculostomy in the management of myelomeningocele-related hydrocephalus: a retrospective study in a single French Institution. World Neurosur. 2016; 87: 484-493.

  16. Tulipan N, Wellons JC 3rd, Thom EA, Gupta N, Sutton LN, Burrows PK et al. Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr. 2015; 16: 613-620.

  17. Elgamal EA. Natural history of hydrocephalus in children with spinal open neural tube defect. Surg Neurol Int. 2012; 3: 112.

  18. Aleksandar JM, Branka S, Radoj I, Meljnikov A. Hydrocephalus: history of surgical treatment over the centuries. Istorija Medicine. 2012; 7: 119-125.

  19. Guía de Práctica Clínica. Prevención, diagnóstico y tratamiento de la espina bífida en niños. México. Instituto Mexicano del Seguro Social 2013.www. CENETEC salud.mx/interior/gpc.html.

  20. Epstein NE, Rosenthal AD, Zito J, Osipoff M. Shunt placement and myelomeningocele repair: simultaneous vs sequential shunting. Review of 12 cases. Childs Nerv Syst. 1985; 1: 145-147.

  21. Hubballah MY, Hoffman HJ. Early repair of myelomeningocele and simultaneous insertion of ventriculoperitoneal shunt: technique and results. Neurosurgery. 1987; 20: 21-23.

  22. Bell WO, Arbit E, Fraser RA. One-stage meningomyelocele closure and ventriculoperitoneal shunt placement. Surg Neurol. 1987; 27: 233-236.

  23. Chadduck WM, Reding DL. Experience with simultaneous ventriculoperitoneal shunt placement and myelomeningocele repair. J Pediatr Surg. 1988; 23: 913-916.

  24. Miller PD, Pollack IF, Pang D, Albright AL. Comparison of simultaneous versus delayed ventriculoperitoneal shunt insertion in children undergoing myelomeningocele repair. J Child Neurol. 1996; 11: 370-372.

  25. Machado HR, Santos de Oliveira R. Simultaneous repair of myelomeningocele and shunt insertion. Child’s Nerv Syst. 2004; 20: 107-109.

  26. Oktem IS, Menkü A, Ozdemir A. When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus? Turk Neurosurg. 2008; 18: 387-391.

  27. Radmanesh F, Nejat F, El Khashab M, Ghodsi SM, Ardebili HE. Shunt complications in children with myelomeningocele: effect of timing of shunt placement. Clinical article. J Neurosurg Pediatr. 2009; 3: 516-520.

  28. Arslan M, Eseoglu M, Gudu BO, Demir I, Kozan A, Gokalp A et al. Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate. Turk Neurosurg. 2011; 21: 397-402.

  29. Sinha SK, Dhua A, Mathur MK, Singh S, Modi M, Ratan SK. Neural tube defect repair and ventriculoperitoneal shunting: indications and outcome. J Neonatal Surg. 2012; 1: 21-24.

  30. Akgun B, Ucler N, Erol FS, Kaplan M, Gediz T, Yilmaz I. The timing of ventriculo-peritoneal shunt application at the late stage myelomeningocele repair. Fırat Tıp Dergisi. 2012; 17: 6-9.

  31. Romero GM, León RA, Carreón GJ, Romero GF. Factores de riesgo de infección del sistema de derivación ventriculoperitoneal en pacientes pediátricos. Enf Inf Microbio. 2013; 34: 59-63.

  32. Arredondo-Navarro LA, Soto MJ, González-González ME, Aguirre- Jauregui O, Soto-Blanquel JL, Angulo CE y cols. Importancia del manejo temprano del mielomeningocele. Estudio comparativo. Rev Med MD. 2013; 4: 73-77.




2020     |     www.medigraphic.com