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

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

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.

Keywords:

Spinal Dysraphia, Myelomeningocele, Neurosurgery, Dura Mater,

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