Lobo Geover Joslen, Nayak Madhukar
Department of Neurosurgery, Father Muller Medical College, Mangaluru, Karnataka, India.
J Pediatr Neurosci. 2018 Oct-Dec;13(4):398-403. doi: 10.4103/JPN.JPN_40_18.
Open neural tube defects in the spine most commonly are in the lumbo-sacral region. Surgical closure is the treatment, but in primary closure the chances of CSF leak are more. Hence a novel technique of using an advancement flap called the V-Y plasty for closure of these defects(6). Our study compares the outcomes of primary closure and V-Y plasty in the closure of Myelomeningocoeles.
A prospective study of the infants who underwent surgical repair for MMC at our hospital from August 2014- January 2018 were included in the study. Total of 22 infants were treated, 9 underwent primary repair and 13 underwent V-Y plasty.
The time taken for primary closure was a mean of 120 min, while the advancement flap took longer of 190.7 min. All the 9 who underwent primary closure had CSF leak, 3 developed hydrocephalus, 6 had wound dehiscence, 3 had neurological deficits and 1 died. Of the 13 infants who underwent V-Y plasty 3 had CSF leaks, 1 had hydrocephalus, 5 had neurological deficits and no wound dehiscence or deaths.
The aim of surgical repair is to cover the exposed neural tissue, prevent CSF leak and reduce CNS infections. V-Y plasty a plastic surgical technique of advancement flaps with intact pedicles improves the outcome of skin closure once the neural placode is placed in the dura and closed. This reduces the morbidity in a one-time procedure.
脊柱开放性神经管缺陷最常见于腰骶部。手术闭合是治疗方法，但一期闭合时脑脊液漏的几率更高。因此，有一种新技术是使用推进皮瓣即V-Y成形术来闭合这些缺陷（6）。我们的研究比较了一期闭合和V-Y成形术在闭合脊髓脊膜膨出中的效果。
对2014年8月至2018年1月在我院接受脊髓脊膜膨出手术修复的婴儿进行前瞻性研究。共治疗22例婴儿，9例行一期修复，13例行V-Y成形术。
一期闭合平均用时120分钟，而推进皮瓣用时更长，为190.7分钟。所有9例行一期闭合的患儿均发生脑脊液漏，3例发生脑积水，6例伤口裂开，3例有神经功能缺损，1例死亡。13例行V-Y成形术的婴儿中，3例发生脑脊液漏，1例发生脑积水，5例有神经功能缺损，无伤口裂开或死亡病例。
手术修复的目的是覆盖暴露的神经组织，防止脑脊液漏并减少中枢神经系统感染。V-Y成形术是一种带完整蒂的推进皮瓣整形手术技术，一旦神经基板置于硬脑膜并闭合，可改善皮肤闭合效果。这在一次手术中降低了发病率。
