Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Paediatric Neurosurgery, Sydney Children's Hospital Randwick, Sydney, Australia.
Adv Tech Stand Neurosurg. 2023;47:49-64. doi: 10.1007/978-3-031-34981-2_3.
An open neural tube defect (ONTD) features an exposed, unclosed neural plate in the form of an expanded and frequently hefty neural placode. Traditional philosophy of ONTD repair aims at preserving the placode at any cost, which often means stuffing the entire thick and unwieldy but non-functional tissue into a tight dural sac, increasing the likelihood of future tethering of the spinal cord. The same philosophy of attempting to save the whole perimetry of the placode also sometimes leads to inadvertent inclusion of parts of the squamous epithelial membrane surrounding the placode into the reconstructed product, only to form inclusion dermoid cyst causing further injury to the neural tissues. Lastly, unsuccessful neurulation of the caudal primary neural tube almost always adversely affects junctional and secondary neurulation resulting in a defective conus, often with a locally active sacral micturition centre that is isolated from and therefore lacking suprasegmental inhibitory moderation. This frequently leads to the development of a spastic, hyperactive, low-compliance and high-pressure bladder predisposing to upstream kidney damage, without benefits of normal bladder function. We are introducing a new surgical technique designed to minimise or eliminate these three undesirable complications of conventional ONTD closure.
开放性神经管缺陷（ONTD）的特征是暴露的、未闭合的神经板呈扩张的、经常是粗大的神经基板形式。传统的 ONTD 修复理念旨在不惜一切代价保留基板，这通常意味着将整个厚而笨拙但无功能的组织塞入紧绷的硬脑膜囊中，增加将来脊髓拴系的可能性。同样的理念，即试图保留基板的整个周界，有时也会导致意外地将基板周围的鳞状上皮膜的部分包含在重建产物中，从而形成包涵性皮样囊肿，进一步损伤神经组织。最后，尾部初级神经管的不成功神经形成几乎总是对连接和次级神经形成产生不利影响，导致缺陷的圆锥，通常伴有局部活跃的骶部排尿中枢，与上位中枢隔离，因此缺乏上位中枢的抑制调节。这常常导致痉挛性、高反应性、低顺应性和高压膀胱的发展，容易导致上游肾脏损伤，而没有正常膀胱功能的益处。我们正在引入一种新的手术技术，旨在最小化或消除传统 ONTD 闭合的这三个不良并发症。
