McDowell Michael M, Lee Philip S, Foster Kimberly A, Greene Stephanie
Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Pediatr Neurosurg. 2018;53(2):100-107. doi: 10.1159/000485251. Epub 2018 Jan 10.
Myelomeningocele (MMC) is an open neural tube defect routinely surgically closed within 48 h of birth to prevent secondary infection. Up to 18% of patients experience wound complications, and 85% require shunting for hydrocephalus. We hypothesized that wound complications could be reduced by cerebrospinal fluid (CSF) diversion at the time of closure.
Institutional review board approval was obtained to review records of the 88 patients who underwent MMC closure between January 2005 and June 2016 at the Children's Hospital of Pittsburgh. Twenty-three patients (26%) had an external ventricular drain (EVD) placed at the time of MMC closure and underwent 7-11 days of CSF drainage. Fourteen patients (16%) had a shunt placed at the time of MMC closure, and 51 (58%) had no form of CSF diversion at the time of MMC closure.
Patients with an EVD or shunt placed at the time of closure had no wound complications. In contrast, 8 patients (16%) without CSF diversion at closure developed wound complications (p = 0.048). Seven of the 8 wound complications occurred in the 71 patients with evidence of hydrocephalus at birth (p = 0.98). Of patients with evidence of hydrocephalus at the time of MMC closure, wound complications had a higher rate of occurrence among patients who did not receive a shunt or EVD at closure (p = 0.01). When comparing only patients with evidence of hydrocephalus at birth, the EVD group alone had a lower rate of wound complications than patients who did not receive CSF diversion at the time of closure (p = 0.031).
These results suggest that addressing hydrocephalus at the time of MMC closure significantly reduces the likelihood of wound complications and may justify temporary CSF diversion at birth, at least in those patients manifesting hydrocephalus.
脊髓脊膜膨出（MMC）是一种开放性神经管缺陷，通常在出生后48小时内进行手术闭合，以预防继发感染。高达18%的患者会出现伤口并发症，85%的患者需要进行分流术治疗脑积水。我们推测，在闭合手术时进行脑脊液（CSF）分流可以减少伤口并发症。
获得机构审查委员会批准，对2005年1月至2016年6月在匹兹堡儿童医院接受MMC闭合手术的88例患者的记录进行审查。23例患者（26%）在MMC闭合手术时放置了外部脑室引流管（EVD），并进行了7至11天的脑脊液引流。14例患者（16%）在MMC闭合手术时放置了分流管，51例患者（58%）在MMC闭合手术时未进行任何形式的脑脊液分流。
在闭合手术时放置EVD或分流管的患者没有伤口并发症。相比之下，8例（16%）在闭合手术时未进行脑脊液分流的患者出现了伤口并发症（p = 0.048）。8例伤口并发症中的7例发生在71例出生时有脑积水证据的患者中（p = 0.98）。在MMC闭合手术时有脑积水证据的患者中，在闭合手术时未接受分流管或EVD的患者伤口并发症发生率更高（p = 0.01）。仅比较出生时有脑积水证据的患者时，仅EVD组的伤口并发症发生率低于在闭合手术时未接受脑脊液分流的患者（p = 0.031）。
这些结果表明，在MMC闭合手术时处理脑积水可显著降低伤口并发症的可能性，并且可能证明在出生时进行临时脑脊液分流是合理的，至少对于那些表现出脑积水的患者是如此。
