Sriharsha R, Kataria Ketan K, Meena Shyam, Jangra Kiran, Bloria Summit
Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Surg Neurol Int. 2020 Mar 13;11:45. doi: 10.25259/SNI_461_2019. eCollection 2020.
Meningoceles are congenital herniation of meninges and cerebrospinal fluid (CSF) through the skull and are bereft of any cerebral tissue. They are commonly found over the anterior fontanelle. Although some cases of cervical dysraphism have been described in the literature, a true meningocele has rarely been seen. The child usually presents with hydrocephalus with features of raised increased intracranial pressure. Sensory, motor, and sphincter functions may be involved depending on the level of lesion. Closure of meningocele should be ideally done within the first 48 h of birth.
Complications associated with meningocele range from learning disabilities, seizures, and bowel dysfunction to complete paralysis below the level of the lesion. The postoperative complications reported are wound infection, CSF leak/collection, urinary tract infection, deterioration of deficit, and death. Here, we present a postoperative case of an 11-month-old child with cervical meningocele who had an unusual complication almost 2 h after an uneventful surgery in the form of sudden cardiorespiratory arrest was revived successfully.
A meningocele surgery is usually not associated with severe postoperative complications which can be encountered in meningomyelocele surgery. Here, in our case, the child with uneventful meningocele surgery arrested 2 h postsurgery with the possible cause being cervical cord edema. Hence, a lesson was learned that strict vigilance is also required in postoperative care for meningocele patients.
脑脊膜膨出是指脑膜和脑脊液通过颅骨先天性疝出,不伴有任何脑组织。常见于前囟。虽然文献中描述过一些颈椎神经管闭合不全的病例,但真正的脑脊膜膨出很少见。患儿通常表现为脑积水及颅内压升高的特征。感觉、运动和括约肌功能可能根据病变水平而受累。脑脊膜膨出的闭合理想情况下应在出生后的头48小时内完成。
脑脊膜膨出相关并发症包括学习障碍、癫痫发作、肠道功能障碍以及病变水平以下的完全瘫痪。报告的术后并发症有伤口感染、脑脊液漏/积聚、尿路感染、神经功能缺损恶化及死亡。在此,我们报告一例11个月大患有颈椎脑脊膜膨出的患儿术后病例,该患儿在手术顺利进行近2小时后出现了异常并发症,表现为突然的心搏呼吸骤停,但成功复苏。
脑脊膜膨出手术通常不会出现脊髓脊膜膨出手术中可能遇到的严重术后并发症。在我们的病例中,该患儿脑脊膜膨出手术顺利,但术后2小时出现心搏呼吸骤停,可能原因是颈髓水肿。因此,我们得到一个教训,即对脑脊膜膨出患者的术后护理也需要严格警惕。