Meningosel ve miyelomeningosel nedeni ile opere edilen 0-1 yaş çocuklarda sentetik dura ile otolog dura kullanımının komplikasyon gelişimi açısından karşılaştırılması

Yıl 2023, Cilt: 33 Sayı: 4, 412 - 420, 31.08.2023

Emir İzci , Fatih Keskin , Densel Araç

https://doi.org/10.54005/geneltip.1260062

Öz

Özet:
Amaç: Bu çalışmanın amacı meningosel ve miyelomeningosel nedeni ile opere edilen 0-1 yaş çocuklarda sentetik dura ile otolog dura kullanımının komplikasyon gelişimi açısından karşılaştırılmasıdır.
Gereç ve yöntemler: Kesitsel tipte gözlemsel araştırma tasarımına sahip bu araştırma, bir üniversite hastanesi beyin ve sinir cerrahisi kliniğinde Kasım 2010 ve Aralık 2016 meningosel ve miyelomeningosel nedeni ile opere edilen 0-1 yaş arası 44 çocuk ile yürütülmüştür. Hasta verileri hastane kayıtlarından retrospektif olarak taranmıştır. Anne ve bebeklerin demografik özellikleri, gestasyonel ve klinik özellikleri, ameliyat sonrası sekonder cerrahi ihtiyacı ve postoperatif enfeksiyon, nekroz, yara açılması ve nörolojik defisit gelişme durumları, sentetik dura ve otolog dura kullanılan hastalar arasında karşılaştırılmıştır.
Bulgular: Toplamda, 4 bebeğin %86,4’ü preterm iken, çoğunda baskın nörolojik durum plejidir. Yarısından fazlasında defekt lomber bölgede izole iken, %77,3’ünde miyelomeningosel saptanmıştır. Hastalarda saptanan defekt boyutu medyan değeri 20,0 cm2 iken, 30 hastada primer kapama, 14’ünde Limberg flebi prosedürü uygulanmış, hastaların yarısında otolog diğer yarasında ise sentetik dura kullanılmıştır. Sentetik dura kullanılan hastalarda defekt boyutu daha fazla iken, bu hastalarda daha fazla sıklıkta hidrosefali saptanmıştır. Otolog dura kullanılan hastaların hepsinde primer kapama uygulanmışken, sentetik dura kullanılan hastaların üçte birinde primer kapama, üçte ikisinde ise Limberg flebi prosedürü uygulanmıştır. Sentetik dura kullanılmış hastalarda daha fazla sıklıkta sekonder cerrahi ihtiyacı gelişmişken, bu hastalarda tüm postoperatif komplikasyonlar daha fazla sıklıkta gözlenmiştir. Ayrıca, primer kapatmaya göre, Limber flebi uygulanan hastalarda da sekonder cerrahi ihtiyacı ve postoperatif nekroz, yara açılması ve nörolojik defisit daha fazla sıklıktadır. Ancak sentetik dura kullanılan hastalarda primer kapatma ve Limberg flebi prosedürleri arasında sekonder cerrahi ihtiyacı ve postoperatif komplikasyon riski benzer bulunmuştur.
Sonuç: Sentetik dura kliniği daha ağır hastalarda kullanılmakla beraber, otolog dura ile karşılaştırıldığında daha fazla sekonder cerrahi ihtiyacı ve daha fazla komplikasyon riskine sahiptir. Sentetik dura kullanılan hastalarda ise primer kapama ve Limberg flebi benzer etkinlik ve güvenliğe sahiptir.

Anahtar Kelimeler

Spinal Disrafi, Miyelomeningosel, Sinir Cerrahisi, Dura Mater

Comparison of Synthetic Dura and Autologous Dura in Terms of Complication Development in Children Aged 0-1 Years Who Underwent Surgery for Meningocele and Myelomeningocele

Öz

Abstract:
Aim: The aim of this study is to compare the usage of synthetic and autologous dura mater in terms of complication risk in 0-1-year-old children who were operated for meningocele and myelomeningocele.
Material and Methods: This cross-sectional observational study was conducted with 44 children aged 0-1 years who were operated for meningocele and myelomeningocele in a university hospital neurosurgery clinic between November 2010 and December 2016. Patient data were extracted retrospectively from hospital records. The demographics and gestational and clinical features of the mothers and babies, and the need for secondary surgery and the presence of postoperative infection, necrosis, wound dehiscence, and/or neurological deficit were compared between the cases who synthetic dura mater was used in their surgery and those autologous dura was used in their surgery.
Results: In total, 86.4% of the 44 infants were preterm, and the predominant neurological problem was plegia in the vast majority. While the defect was located in the lumbar region in more than half of them, myelomeningocele was detected in 77.3% of all cases. The median defect size detected in the patients was 20.0 cm2, primary closure was performed in 30 patients, Limberg flap procedure in 14 patients, however, autologous dura mater and synthetic dura mater were used equally in the patients. The defect size was larger in patients using synthetic dura, furthermore hydrocephalus was found more frequently in these patients. While primary closure was applied in all patients using autologous dura and in one third of the patients using synthetic dura, Limberg flap procedure was applied in two thirds of synthetic dura group. The need for secondary surgery developed more frequently in synthetic dura group, and all postoperative complications were observed more frequently in these patients. In addition, the need for secondary surgery and postoperative necrosis, wound dehiscence, and neurologic deficit are more frequent in patients who underwent Limber flap compared to primary closure. However, the need for secondary surgery and the risk of postoperative complications were similar between primary closure and Limberg flap procedures in synthetic dura group.
Conclusion: Although the synthetic dura mater was used in more severe patients, it had a higher need for secondary surgery and a higher risk of complications compared to autologous dura. In patients using synthetic dura, on the other hand, primary closure and Limberg flap had similar efficacy and safety.

Anahtar Kelimeler

Spinal Dysraphia, Myelomeningocele, Neurosurgery, Dura Mater

Kaynakça

• Copp AJ, Adzick NS, Chitty LS, et al. Spina bifida. Nature reviews Disease primers. 2015;1:15007.
• International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Annual Report 2014. Rome, Italy: International Centre on Birth Defects-ICBDSR Centre; 2014.
• Blount JP, Bowman R, Dias MS, et al. Neurosurgery guidelines for the care of people with spina bifida. Journal of pediatric rehabilitation medicine. 2020;13(4):467-77.
• Adzick NS, Thom EA, Spong CY, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. The New England journal of medicine. 2011;364(11):993-1004.
• Johnson MP, Bennett KA, Rand L, et al. The Management of Myelomeningocele Study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. American journal of obstetrics and gynecology. 2016;215(6):778.e1-.e9.
• Farmer DL, Thom EA, Brock JW, 3rd, et al. The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes. American journal of obstetrics and gynecology. 2018;218(2):256.e1-.e13.
• Shobeiri P, Presedo A, Karimi A, et al. Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature. Journal of orthopaedic surgery and research. 2021;16(1):494.
• Shim JH, Hwang NH, Yoon ES, et al. Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair. Archives of plastic surgery. 2016;43(1):26-31.
• Banda CH, Narushima M, Ishiura R, et al. Local Flaps with Negative Pressure Wound Therapy in Secondary Reconstruction of Myelomeningocele Wound Necrosis. Plastic and reconstructive surgery Global open. 2018;6(12):e2012.
• Sharma MK, Kumar N, Jha MK, et al. Experience with various reconstructive techniques for meningomyelocele defect closure in India. JPRAS open. 2019;21:75-85.
• Miyabe MM, Murphy KP, Oria M, et al. Dural substitutes for spina bifida repair: past, present, and future. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2022;38(5):873-91.
• von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. 2007;18(6):800-4.
• Nejat F, Baradaran N, Khashab ME. Large myelomeningocele repair. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India. 2011;44(1):87-90.
• Caldarelli M, Rocco CD. Myelomeningocele Primary Repair Surgical Technique. In: Memet Özek M, Cinalli G, Maixner WJ, editors. The Spina Bifida: Management and Outcome. Milano: Springer Milan; 2008. p. 143-55.
• Formentin C, de Andrade EJ, Matias LG, et al. Using the keystone design perforator island flap in large myelomeningocele closure. Neurosurgical focus. 2019;47(4):E19.
• Rankin TM, Wormer BA, Tokin C, et al. Quadruple Perforator Flaps for Primary Closure of Large Myelomeningoceles: An Evaluation of the Butterfly Flap Technique. Annals of plastic surgery. 2019;82(6S Suppl 5):S389-s93.
• Lien SC, Maher CO, Garton HJ, et al. Local and regional flap closure in myelomeningocele repair: a 15-year review. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2010;26(8):1091-5.
• Kesan K, Kothari P, Gupta R, et al. Closure of large meningomyelocele wound defects with subcutaneous based pedicle flap with bilateral V-Y advancement: our experience and review of literature. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery [et al] = Zeitschrift fur Kinderchirurgie. 2015;25(2):189-94.
• Emsen IM. Closure of Large Myelomeningocele Defects Using the O-S Flap Technique. The Journal of craniofacial surgery. 2015;26(7):2167-70.
• Kattan AE, Alsufayan FA, Alammar AK, et al. Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients. Plastic and reconstructive surgery Global open. 2020;8(9):e3095.
• Lobo GJ, Nayak M. V-Y Plasty or Primary Repair Closure of Myelomeningocele: Our Experience. Journal of pediatric neurosciences. 2018;13(4):398-403.
• Atalay T, Oktay K, Guzel E, et al. Comparison of dorsal intercostal perforator artery flap and primary closure in myelomeningocele repair. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2021;37(1):229-33.
• Mohamed M, Ragaee M, Ali W, et al. Standard protocol for closure and repair of post-meningocele and meningomyelocele back skin defect. 2019;4(1):104-8.
• Kemaloğlu CA, Özyazgan İ, Ünverdi Ö F. A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair. Journal of neurosurgery Pediatrics. 2016;18(2):187-91.
• Pignatti M, Feletti A, Sapino G, et al. Myelomeningocele Repair Combining a Double Cryopreserved Amniotic Membrane Homograft and the Keystone Flap in a 3-Year-Old Child: A Case Report. Pediatric neurosurgery. 2020;55(2):106-12.
• Grigoryants V, Jane JA, Jr., Lin KY. Salvage of a complicated myelomeningocele using collagen (Duragen) and dermal (Alloderm) matrix substitutes. Case report and review of the literature. Pediatric neurosurgery. 2007;43(6):512-5.
• de Weerd L, Sjåvik K, Pedersen LK, et al. Triple Use of Autologous Amnion Graft in the Treatment of Meningomyelocele and Split Cord Malformation. Plastic and reconstructive surgery Global open. 2020;8(1):e2539.
• Hoffman HJ, Taecholarn C, Hendrick EB, et al. Management of lipomyelomeningoceles. Experience at the Hospital for Sick Children, Toronto. Journal of neurosurgery. 1985;62(1):1-8.
• Pettorini BL, Tamburrini G, Massimi L, et al. The use of a reconstituted collagen foil dura mater substitute in paediatric neurosurgical procedures--experience in 47 patients. British journal of neurosurgery. 2010;24(1):51-4.
• Susarla SM, Hauptman J, Ettinger R, et al. Acellular Dermal Matrix as a Definitive Reconstructive Option for Management of a Large Myelomeningocele Defect in the Setting of Severe Lumbar Kyphosis. World neurosurgery. 2019;129:363-6.
• Samuels R, McGirt MJ, Attenello FJ, et al. Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2009;25(9):1085-9.
• Thompson DN, Taylor WF, Hayward RD. Silastic dural substitute: experience of its use in spinal and foramen magnum surgery. British journal of neurosurgery. 1994;8(2):157-67.
• Bartal AD, Heilbronn YD, Plashkes YY. Reconstruction of the dural canal in myelomeningocele. Case report. Plastic and reconstructive surgery. 1971;47(1):87-9.
• Venes JL. Surgical considerations in the initial repair of meningomyelocele and the introduction of a technical modification. Neurosurgery. 1985;17(1):111-3.
• Nakazawa H, Kikuchi Y, Honda T, et al. Successful management of a small infant born with a large meningomyelocele using a temporary artificial dermis. Scandinavian journal of plastic and reconstructive surgery and hand surgery. 2005;39(1):53-6.