Senem ALKAN ÖZDEMİR, Nail ÖZDEMİR, Haydar ÇELİK, Esra ARUN ÖZER

SERVİKAL MENİNGOMYELOSELLİ İKİ OLGU SUNUMUNUN KLİNİK VE CERRAHİ YÖNETİMİ

AMAÇ: Servikal yerleşimli meningomyeloseller; torakal, lomber ve sakral lokalizasyonlu olanlardan farklıdır. Çalışmamızda; servikal meningomyeloselin kliniğini, eşlik eden anomalileri, radyolojisini, cerrahi öncesi ve sonrasındaki hasta izlemini, cerrahi yaklaşımı ve prognozunu değerlendirmeyi amaçladık.GEREÇ VE YÖNTEMLER: 1 Ocak 2012 - 31 Aralık 2016 tarihleri arasında meningomyelosel nedeniyle 3. basamak yenidoğan yoğun bakıma yatırılan 88 yenidoğanın 2'si servikal yerleşimliydi. Servikal meningomyeloselli hastaların kliniği, radyolojisi, cerrahi tekniği, cerrahi öncesi ve sonrası yönetimi ile prognozu prospektif olarak incelendi. Hastaların psikomotor gelişimleri postnatal 18. ayda Denver Gelişimsel Tarama Testi ile değerlendirildi.BULGULAR: Ortalama gestasyonel yaşı 39.5 hafta olan bir erkek bir kız yenidoğanın ortalama doğum ağırlıkları 3635 gr ve keselerinin ortalama çapı 5x5 cm idi. Motor defisiti olmayan her iki hastanın manyetik rezonans görüntülemelerinde kese içinde nöral doku izlendi. Ek anomali olarak hidrosefali ve Chiari tip 2 malformasyonu saptandı. Ayrıca olgu 1'de hemivertebra ile rotoskolyoz; olgu 2' de torakal siringomyeli izlendi. Ortalama cerrahiye alınma süreleri postnatal 4.5 gündü. Kese eksizyonu için anestezi ve cerrahi ortalama süresi 2.5 saat olup, ortalama hastanede kalış süreleri tüm nöroşirürji cerrahileri ve yoğun bakım izlem süreleri için 33 gündü. Ortalama izlem süremiz 2.5 yıl olup; ölüm, yara yeri problemi, beyin omurilik sıvısı fistülü ve yara yeri enfeksiyonu yoktu. Postoperatif dönemde ek nörolojik defisit izlenmedi. Her iki hastada da izlem süresince ventriküloperitoneal şanta ait bir sorun yaşanmadı. Nörolojik muayenesi ve Denver Gelişimsel Tarama Testi-II'ye göre psikomotor gelişimleri her iki hastada da normaldi.SONUÇ: Servikal meningomyeloselin; torakolomber ve lumbosakral yerleşimliler ile kıyaslandığında klinik prezentasyonları, cerrahi sonuçları, prognozu ve psikomotor gelişimleri daha iyidir

CLINICAL AND SURGICAL MANAGEMENT OF THE CERVICAL MENINGOMYELOCELE IN THE TWO CASE REPORTS

OBJECTIVE: Meningomyelocele of the cervical region different from thoracal, lumbar, and sacral. In our study, we aimed to evaluate the clinical characteristics, radiology, associated anomalies, pre and postoperative follow-up, surgical strategy, and prognosis with cervical meningomyelocele.MATERIAL AND METHODS: From 1 January 2012 to 31 December 2016, a total of 88 neonates were diagnosed as meningomyelocele our level III intensive care unit, and 2 of them recognized to be cervical region. The clinical symptoms, radiological features, operative approaches, preoperative care, postoperative management and prognosis were noted prospectively. At 18 months postnatal period the children were assessed by the Denver Development Screening Test-II for psychomotor delay.RESULTS: The procedure was performed on one female and one male. Mean birth weight and gestational age were 3635 gram and 39.5 weeks, respectively. The mean size in sac was 5x5 cm. There was no neurological motor deficits in our two neonates. Magnetic resonance imaging showed that neural tissue within the sac, hydrocephaly and Chiari type 2 malformation. Hemivertebrae and rotoscoliosis was present in patient 1. Syringomyelia of the thoracal region was present in patient 2. The mean age of the neonates at the time of surgery was 4.5 days. The mean lenght of the combined anesthesia and surgery procedure was 2.5 hours. The mean hospital stay, determined by the neonatology and neurosurgery team, was 33 days. The mean follow-up period for our cases was 2.5 years. There were no mortality, wound problems, cerebro-spinal fluid fistula and wound infection. No additional neurological deficits were present postoperatively. There was no problems of ventriculoperitoneal shunt during the follow-up in our patients. Neurological examination and pyschomotor examination with the Denver Development Screning Test-II was normal in two cases.CONCLUSION: The clinical presentations, results of surgery, prognosis, and psychomotor development of cervical meningomyelocele is better than of patients with thoracolumbar and lumbosacral locations of meningomyelocele

PDF

___

1)Andronikou S, Wieselthater N, Fieggen AG. Cervical spina bifida cystica: MRI differentiation of the subtypes in children. Childs Nerv Syst. 2006; 22: 379-84.
2)Salomao JF, Cavalheiro S, Matushita H, Leibinger RD, Bellas AR, Vanazzi E, et al. Cystic spinal dyspraphism of the cervical and upper thoracic region. Childs Nerv Syst. 2006; 22: 234-42.
3)Kasliwal MK, Dwarakanath S, Mahapatra AK. Cervical meningomyelocele-an instutional experience. Childs Nerv Syst. 2007; 23: 1291-3.
4)Huang SL, Shi W, Zhang LG. Characteristics and surgery of cervical myelomeningocele. Childs Nerv Syst. 2010; 26: 87-91.
5)Sun JC, Steinbok P, Cochrane DD. Cervical myelocystoceles and meningoceles: long-term follow-up. Pediatr Neurosurg. 2000; 33: 118-22.
6)Pang D, Dias MS. Cervical myelomeningoceles. Neurosurgery. 1993; 33: 363-73.
7)Meyer-Heim AD, Klein A, Boltshauser E. Cervical myelomeningocele. Follow-up of five patients. Eur J Paediatr Neurol. 2003; 7: 407-12.
8)Frankenburg WK, Doddr J, Archer P, Shapino H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Development Screening Test. Pediatrics. 1992; 89: 91-97.
9)Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J, et al. The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants, Pediatrics. 2006; 117: 1270–80.
10)Feltes CH, Fountas KN, Dimopolous VG, Escurra AI, Boev A, Kapsalaki EZ, et al. Cervical meningocele in association with spinal abnormalities. Childs Nerv Syst. 2004; 20: 357-61.
11)Duprez TP, Laterre EC. Unusual form of closed dyspraphysm of the cervical spine. Acta Neurol Belg. 1995; 95: 42-3.
12)El Shabrawi-Caelen L, White WLI, Soyer HP, Kim BS, Frieden IJ, Mc Calmont TH. Rudimentary meningocele: remnant of a neural tube defect? Arch Dermatol. 2001; 137: 45-50.
13)Rossi A, Piatelli G, Gandolfo G, Pavanello M, Hoffmann C, Van Goethem JW, et al. Spectrum of non terminal myelocystoceles. Neurosurgery. 2006; 58: 509-15.
14)Habibi Z, Nejat F, Tajik P, Kazmi SS, Kajabafzadeh AM: Cervical myelomeningocele. 2006; 58: 1168-75.
15)Afroza S, Ali Z, Prabhakar H. Severe systemic hypotension during repair of leaking large meningomyelocele. J Anest. 2008; 22: 59-60.