Finnegan R, Kehoe J, McMahon O, Donoghue V, Crimmins D, Caird J, Murphy J
Department of Neonatology, Children’s University Hospital, Temple st, Dublin
Department of Neurosurgery, Children’s University Hospital, Temple st, Dublin
Ir Med J. 2019 May 9;112(5):930.
Aim The aim of this study is to outline the role of primary external ventricular drains (EVD) in the management of open myelomeningoceles in the neonatal setting in Ireland. Methods Retrospective cohort study involving all infants who underwent open myelomeningocele repair in a teritary centre in Ireland between January 2009 and April 2016. Medical charts and laboratory data was reviewed on all infants meeting the inclusion criteria. Results One hundred and forty-three neonates underwent open myelomeningocele repair in the 6.5 year period. EVD were inserted at the time of primary wound closure in 19 cases (13%). EVD were used to aid in wound closure and as a primary method of cerebrospinal fluid (CSF) diversion. They remained in place for a median of 8 days, ranging from 1-22 days. All EVD, apart from one, in our series were replaced by a ventricular-peritoneal (VP) shunt at some stage. Conclusion EVD were used in 13% of cases of open myelomeningocele repairs from Jan 2009-Apr 2016 as a primary measure to aid in management. Compared to the cohort in whom an EVD was not inserted at the time of surgery, there was a decrease in the rate of infections. However, there was an increased rate of wound dehiscence/leak and a later need for VP shunt insertion.
目的 本研究旨在概述原发性外置脑室引流管（EVD）在爱尔兰新生儿开放性脊髓脊膜膨出治疗中的作用。方法 回顾性队列研究，纳入2009年1月至2016年4月间在爱尔兰一家三级中心接受开放性脊髓脊膜膨出修补术的所有婴儿。对所有符合纳入标准的婴儿的病历和实验室数据进行回顾。结果 在6.5年期间，143例新生儿接受了开放性脊髓脊膜膨出修补术。19例（13%）在初次伤口缝合时插入了EVD。EVD用于辅助伤口闭合以及作为脑脊液（CSF）分流的主要方法。它们留置的中位时间为8天，范围为1至22天。在我们的系列中，除1例之外，所有EVD在某个阶段均被脑室-腹腔（VP）分流管取代。结论 在2009年1月至2016年4月间的开放性脊髓脊膜膨出修补术病例中，13%使用了EVD作为辅助治疗的主要措施。与手术时未插入EVD的队列相比，感染率有所降低。然而，伤口裂开/渗漏率增加，且后期需要插入VP分流管的比例更高。
