Myelomeningocele excision and repair

Spinal column fissure usually manifests as spinous process and lamina defect, accompanied by developmental malformation of vertebral body and intervertebral foramen, with dominant and recessive. Dominant include simple meningocele with no obvious neurological symptoms and spinal meningocele with neurological dysfunction, and congenital tumors such as lipoma, teratoma, and epithelioid cyst. The deformity of the lamina can be limited to one vertebra, and it can also involve several adjacent vertebrae. In severe cases, the lumbar vertebrae and the atlas vertebral lamina are both split. In a few cases, there may be multiple spina bifida in the full length of the spine, or a combination of a half-vertebral body and a scoliosis. A very small number of severe cases are spinal deformities, and more complicated neurological deficits are difficult to treat. Treatment of diseases: brain swelling and meningocele meningocele and meningococcal bulging Indication Spinal meningocele resection and repair is applicable to: 1. Spinal meninges in various segments of the spine. 2, lipoma type of spinal meningocele. 3, lumbosacral spinal meningocele bulging with part of the limbs and dysfunction of the bowel and bladder. Contraindications 1, huge spinal meningocele, the patient has been in a state of exhaustion. 2, the spinal cord exposed, combined infection or existing soft lower limbs and incontinence. 3, combined with other congenital malformations in other parts, the overall situation is poor. 4, accompanied by severe hydrocephalus. Preoperative preparation The skin is cleaned daily from 3 days before surgery to prevent the stool from contaminating the surgical area. Those with abnormal hair should be cleaned. If the meningocele has ruptured and there is cerebrospinal fluid leakage, the skin is disinfected and protected with a sterile dressing to prevent bacterial infection and brain (cho) inflammation. Surgical procedure 1. Incision It depends on the size and shape of the bulging mass. The incision line is marked with gentian violet in advance. Generally, a straight incision or a fusiform incision is used on the spinous process. When making an incision, the suture and repair of the skin must be fully estimated, and the normal skin should be kept as much as possible, and the suture should not be too tight, so as to avoid poor healing of the incision. If the bulging sac is larger, the cerebrospinal fluid should be punctured before the surgical incision, so that the bulging capsule collapses or shrinks, so as to facilitate the operation and perform the excision and repair of the bulging sac. 2, according to the same method of spinal cleft sulcus excision and repair, free bulging capsule to its base, revealing the lamina defect. For the lumbosacral spinal meninges, in the lower part of the free capsule wall, see if the phrenic nerve is penetrating from the wall of the capsule, and do not injure these nerves. 3. Remove 1 or 2 laminae from the upper and lower parts of the spina bifida to expose the base of the capsule extensively. When the dura mater is cut, it is also convenient to treat the bulged spinal cord and the cauda equina nerve, and at the same time, the spinal cord and cauda equina nerve can be relieved by abnormal epidural tissue. 4, explore the contents of the bulging capsule The wall of the capsule is cut on the side of the top of the bulged capsule. The lesion is located in the cervical or thoracic segment. There is often a styloid-like tissue on the surface of the spinal cord that protrudes into the sac from the sac and adheres to the lateral wall of the sac, which is a degenerated nerve and scar tissue. After being freed, it is also in the subarachnoid space. If the styloid process is long and there is no nerve contact with the surrounding, it can be cut off from the surface of the spinal cord. The dural incision must be enlarged before cutting to see the continuity of the spinal cord. If the styloid process is isolated, it can be removed; if there is a nerve connection, it cannot be blindly cut. Usually, the lesion of the lumbosacral segment is that the distal end of the spinal cord protrudes upward into the sac, and is attached to the anterior wall and the superior wall of the sac, and the cauda equina is then folded back into the distal spinal canal. Avoid damage to the distal cauda equina while cutting the wall. Surgery under the microscope, carefully dissipate the nerve tissue, preferably with a sharp knife to separate the adhesions. The cone and cauda equina are then released and placed in the dural sac. If the nerve tissue is integrated with the wall of the capsule and cannot be separated, it can be included in the subarachnoid space together with a small residual wall. If the spinal canal is abnormal and shallow grooved, it is difficult to accommodate the end of the spinal cord. After the removal of the excess dural sac, the suture repaired the dura mater should be more spacious, artificially forming a dural sac to accommodate the nerve tissue. Avoid sutures that are too narrow to cause compression and adhesion to the conus and the cauda equina. The end of the spinal cord is cut during surgery. 5, for the lipoma type of spinal meningocele The cellulite should be freed and excised during surgery until the bulging sac is revealed. If the fat extends to the spinal cord, the excess adipose tissue can only be cut off from the surface of the spinal cord with a sharp knife, and should not be excessively removed to avoid direct damage to the nerve tissue. 6, suture wound The repair and suture of the meninges, the repair and reinforcement of the muscle layer, and the suturing of the subcutaneous tissue and the skin can be performed by referring to the method of meningocele resection and repair. complication 1. Inappropriate treatment of spinal cord and nerve tissue can aggravate motor and sensory disturbances and bladder and anal sphincter dysfunction. 2, dural suture is not strict, can be complicated by cerebrospinal fluid leakage, and even cause delayed wound healing or complicated brain (ridge) inflammation.