FEATURES OF SURGICAL TREATMENT OF SPINAL DYSRAPHISM OF THE SACRALCOCCYGEAL AREA OF INFANTS
| Autor: | O. B. Bodnar, A. I. Roshka |
|---|---|
| Rok vydání: | 2016 |
| Předmět: | |
| Zdroj: | Clinical anatomy and operative surgery. 15:43-47 |
| ISSN: | 1993-5897 1727-0847 |
| DOI: | 10.24061/1727-0847.15.4.2016.8 |
| Popis: | Spinal dysraphism (SD) of children is a complicated and unsolved problem in pediatric neurosurgery. Pathology of sacral-coccygeal area is 30 % - 50 % of the total number of SD of children. The presence of a large number of nearest complications (wound abscess, meningitis, the gap of the wounds, liquorrhoea) and long-term postoperative period complications (impaired functions of the lower limbs and pelvic organs) are the basis to search for improved methods of treatment. 19 newborns with SD sacral-coccygeal area were operated. 16 children were aged 1 to 10 days and 3 from 11 to 28 days. Depending on the anatomical variants of SD sacral-coccygeal areas they were divided into: meningocele (26,32%); myelomeningoradiculocele (15,78%); myelomeningocele (31,58%). All surgery was performed with the use of microsurgical tools and microsurgical techniques under optical multiplication using electric coagulator for the tissue (EC-300M 1). A favourable condition for better results in the treatment of SD was selection of the optimal timing and techniques of surgery. The best results for surgery were the age of 7 to 10 days (12 children). The term of surgery from 11 until 28 days for 3 children was due to the presence of hernia infection and purulence, which required the implementation of preoperative preparation for 5-7 days. The approach was determined by: hernia localization, size and spine defect, the degree of subcutaneous tissue development, the condition of hernia layers, displacement and plasticity of the back tissues. The disadvantage of all methods of surgical treatment of SD there is a danger of iatrogenic damage to neural elements during surgery, depending on the quality of its performance. While performing surgical treatment of SD microsurgical radiculolysis with precision microsurgical excision of all cicatricial adhesions, cerebrospinal fluid cysts and other intraradicular formations, and thorough revision of the spinal canal should be undertaken. Dysfunction of the pelvic organs (urine and anal incontinence) and lower limbs are observed in 63,16% of children operated on for SD in the neonatal period that requires further development of methods of their surgical correction at a later age. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|