Meningosel ve meningomiyelosel cerrahisi yapılan olguların retrospektif değerlendirilmesi
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Tarih
2021
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Nöral tüp defektleri (NTD) santral sinir sisteminin doğumsal orta hat gelişim anomalileri olarak adlandırılır. Klinikte bu hastalık grubunda en sık görülenler spinaldisrafizm grubunda yer alan meningomiyelosel ve meningoseldir. Meningomiyeloselspinal kordu hafif formundan çok şiddetli formuna kadar değişik derecelerde etkileyebilir. Bu çalışmada kliniğimizemeningomiyelosel ve meningosel tanısı ile cerrahi tedavi uygulanan hastalar retrospektif olarak değerlendirildi. Yaptığımız bu çalışmayla meningomiyelosel ve meningoselin tedavisi ve komplikasyonları ile mücadelede yeni stratejilerin geliştirilmesine yardımcı olmakamaçlanmıştır. Yöntem: Bu çalışma Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Beyin ve Sinir Cerrahisi Kliniğinde gerçekleştirildi. Çalışmaya;2018-kasım 2020 tarihleri arasında meningosel ve miyelomeningosel tanıları ile opere edilmiş hastalar dahil edildi. Bulgular: Retrospektif olarak yapılan bu çalışmaya, %51,2'si (n=42) erkek, %48,8'i (n=40) kız olmak üzere toplam 82 meningosel ve miyelomeningosel tanısı ile opere edilmiş hastalar dahil edilmiştir. Hastaların % 9,80'inde (n=8) meningosel, %90,20 'sinde (n=74) miyelomeningosel mevcuttu. Araştırmaya alınan bebeklerin gestasyonel yaş ortalaması 36,04±2,08 (30,00-39,00) , annelerin yaş ortalaması 27,55±5,56 (18,00-44,00) bulundu. Bebeklerin operasyon öncesindeki nörolojik muayene durumları incelendiğinde; %64,6 'sında (n=53) parapleji, %25,6'sında (n=21) parezi olduğu tespit edildi. Bebeklerin %9,8 'inde (n=8) kas gücü kaybı yoktu. Çalışmaya dahil edilen bebeklerin kese lezyon seviyelerine göre ayrıldığında; %62,2 'si (n=51) lomber, %23,2'si (n=19) lumbosakral, %8,5'i (n=7) torakolomber , % 6,1'i (n=5) torakal bölgede olduğu gözlendi. Hastalar ortalama 4,00±7,87 (1,00-36,00) günlük iken opere edildiği gözlendi. Opere edilen bebeklerin % 45,10'sinde (n=37) primer kapatma, % 54,90'ına (n=45) flep çevrilerek kapatma tekniği uygulandığı izlendi. . Operasyon sırasında bebeklerin % 22,00'ında (n=18) sentetik dura kullanıldığı tespit edildi. Opere edildikten sonra gerek görülen hastalara ortalama 20,00±16,99 (1,00-73,00) günlük iken şant takıldığı belirlendi. Operasyon sonrası hastaların % 24,40'ında (n=20) BOS fistülü geliştiği gözlendi. Sonuç:Meningosel ve meningomiyelosel hastalarının tedavilerinde multidisipliner yaklaşılması ve komplikasyonların ve eşlik eden anomalilerin de göz önünde bulundulması önemlidir. Kese cerrahisinde de mümkün oldukça hastanın kendi durası ve primer cilt kapatmanın tercih edilmesi önerilmektedir.
Aim: Neural tube defects (NTDs) are called congenital midline developmental anomalies of the central nervous system. Meningomyelocele and meningocele, which are in the spinal dysraphism group, are the most common in this disease group. Meningomyelocele can affect the spinal cord in varying degrees from mild to very severe forms. In this study, patients who underwent surgery for meningomyelocele and meningocele in our clinic were evaluated retrospectively. With this study, we aimed to help develop new strategies in the treatment of meningomyelocele and meningocele and their complications. Methods: This study was carried out in Necmettin Erbakan University Meram Medical Faculty Brain and Nerve Surgery Clinic. Patients who were operated with the diagnosis of meningocele and myelomeningocele between 2018 and November 2020 were included in the study. Results: This retrospective study included 82 meningocele and myelomeningocele patients, 51.2% (n = 42) male and 48.8% (n = 40) female. 9.80% (n = 8) of the patients had meningocele and 90.20% (n = 74) had myelomeningocele. The mean gestational age of the babies included in the study was 36.04 ± 2.08 (30.00-39.00), and the mean age of the mothers was 27.55 ± 5.56 (18.00-44.00). When the pre-operative neurological examination status of babies is examined; It was found that 64.6% (n = 53) had paraplegia and 25.6% (n = 21) had paresis. There was no loss of muscle strength in 9.8% (n = 8) of the babies. When the bladder is separated according to the lesion levels of the babies included in the study; 62.2% (n = 51) lumbar, 23.2% (n = 19) lumbosacral, 8.5% (n = 7) thoracolumbar, 6.1% (n = 5) It was observed to be in the thoracic region. It was observed that the patients were operated when they were 4.00 ± 7.87 (1.00-36.00) days on average. It was observed that primary closure technique was applied in 45.10% (n = 37) of the operated babies, and closure technique was applied by turning flap to 54.90% (n = 45). . It was found that synthetic dura was used in 22.00% (n = 18) of the babies during the operation. It was determined that shunt was applied to patients who were deemed necessary after the operation when they were 20.00 ± 16.99 (1.00-73.00) days. It was observed that CSF fistula developed in 24.40% (n = 20) of the patients after the operation. Conclusion: In the treatment of meningocele and meningomyelocele patients, it is important to have a multidisciplinary approach and to consider complications and accompanying anomalies. In pouch surgery, it is recommended to prefer the patient's own dura and primary skin closure whenever possible.
Aim: Neural tube defects (NTDs) are called congenital midline developmental anomalies of the central nervous system. Meningomyelocele and meningocele, which are in the spinal dysraphism group, are the most common in this disease group. Meningomyelocele can affect the spinal cord in varying degrees from mild to very severe forms. In this study, patients who underwent surgery for meningomyelocele and meningocele in our clinic were evaluated retrospectively. With this study, we aimed to help develop new strategies in the treatment of meningomyelocele and meningocele and their complications. Methods: This study was carried out in Necmettin Erbakan University Meram Medical Faculty Brain and Nerve Surgery Clinic. Patients who were operated with the diagnosis of meningocele and myelomeningocele between 2018 and November 2020 were included in the study. Results: This retrospective study included 82 meningocele and myelomeningocele patients, 51.2% (n = 42) male and 48.8% (n = 40) female. 9.80% (n = 8) of the patients had meningocele and 90.20% (n = 74) had myelomeningocele. The mean gestational age of the babies included in the study was 36.04 ± 2.08 (30.00-39.00), and the mean age of the mothers was 27.55 ± 5.56 (18.00-44.00). When the pre-operative neurological examination status of babies is examined; It was found that 64.6% (n = 53) had paraplegia and 25.6% (n = 21) had paresis. There was no loss of muscle strength in 9.8% (n = 8) of the babies. When the bladder is separated according to the lesion levels of the babies included in the study; 62.2% (n = 51) lumbar, 23.2% (n = 19) lumbosacral, 8.5% (n = 7) thoracolumbar, 6.1% (n = 5) It was observed to be in the thoracic region. It was observed that the patients were operated when they were 4.00 ± 7.87 (1.00-36.00) days on average. It was observed that primary closure technique was applied in 45.10% (n = 37) of the operated babies, and closure technique was applied by turning flap to 54.90% (n = 45). . It was found that synthetic dura was used in 22.00% (n = 18) of the babies during the operation. It was determined that shunt was applied to patients who were deemed necessary after the operation when they were 20.00 ± 16.99 (1.00-73.00) days. It was observed that CSF fistula developed in 24.40% (n = 20) of the patients after the operation. Conclusion: In the treatment of meningocele and meningomyelocele patients, it is important to have a multidisciplinary approach and to consider complications and accompanying anomalies. In pouch surgery, it is recommended to prefer the patient's own dura and primary skin closure whenever possible.
Açıklama
Anahtar Kelimeler
Nöroşirürji, Neurosurgery, Meningosel, Meningocele, Nöral tüp defekti, Neural tube defect
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sert, O. (2021). Meningosel ve meningomiyelosel cerrahisi yapılan olguların retrospektif değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Beyin Cerrahisi Anabilim Dalı, Konya.
