63704 Repair of myelomeningocele; less than 5 cm diameter

Name of the Procedure:

Repair of Myelomeningocele; less than 5 cm diameter

Summary

The repair of myelomeningocele is a surgical procedure designed to correct a birth defect where a baby's spinal cord fails to develop properly. This involves closing a small defect, typically less than 5 centimeters in diameter, on the spinal column to prevent further complications.

Purpose

Medical Condition or Problem Addressed:

Myelomeningocele, a type of spina bifida where the spinal cord and its protective covering protrude through an opening in the spine.

Goals or Expected Outcomes:

• To prevent infections and further damage to the spinal cord.
• To improve neurological function and overall quality of life.
• To allow for proper growth and development.

Indications

Symptoms or Conditions:

• Visible sac or protrusion on the baby's back.
• Loss of bladder or bowel control.
• Weakness or paralysis in the legs. ##### Patient Criteria: Newborns diagnosed with myelomeningocele, typically identified through prenatal imaging or post-birth examination.

Preparation

Pre-Procedure Instructions:

• Fasting guidelines for the baby, typically required if using general anesthesia.
• Discontinue certain medications as directed by the healthcare provider. ##### Diagnostic Tests:
• MRI or ultrasound to precisely locate the spinal defect.
• Blood tests to check overall health and readiness for surgery.

Procedure Description

Step-by-Step Explanation:

1. Administer anesthesia to ensure the baby is asleep and pain-free.
2. Make an incision around the myelomeningocele sac.
3. Carefully reposition the spinal cord and nerves back into the spinal canal.
4. Close the defect using layers of muscle, fat, and skin to cover and protect the spinal cord.
5. Apply surgical dressings.

Tools, Equipment, or Technology:

• Surgical scalpel and scissors.
• Sutures and surgical adhesives.
• Anesthesia equipment.

Anesthesia:

General anesthesia is typically used, ensuring the baby is unconscious and pain-free.

Duration

The procedure typically takes around 2 to 3 hours.

Setting

The procedure is performed in a hospital's operating room.

Personnel

• Pediatric neurosurgeons
• Pediatric anesthesiologists
• Surgical nurses

Risks and Complications

Common Risks:

• Infection at the surgical site.
• Bleeding. ##### Rare Risks:
• Damage to the spinal cord or nerves.
• Cerebrospinal fluid leakage.

Possible Complications:

• Managing infections with antibiotics.
• Additional surgeries if complications arise.

Benefits

Expected Benefits:

• Protection of the spinal cord from further damage and infection.
• Improvement in mobility and neurological function. ##### Timeframe: Benefits can be observed soon after recovery, with long-term developmental improvements.

Recovery

Post-Procedure Care:

• Monitoring in the neonatal intensive care unit (NICU).
• Pain management with prescribed medications. ##### Expected Recovery Time:
• Initial recovery in the hospital may take 1 to 2 weeks.
• Longer-term follow-up visits and physical therapy may be needed.

Alternatives

Other Treatment Options:

• Prenatal surgery if diagnosed early in pregnancy.
• Supportive care and physiotherapy in less severe cases. ##### Pros and Cons of Alternatives:
• Prenatal surgery may reduce complications but carries risks to both mother and baby.
• Supportive care doesn't correct the defect but can improve quality of life.

Patient Experience

During the Procedure:

The baby will be under general anesthesia, ensuring no awareness or pain.

After the Procedure:

• Some discomfort managed with medications.
• Close observation in the NICU.
• Gradual return to feeding and normal activities.