Name of the Procedure:

Repair of Myelomeningocele; Larger than 5 cm Diameter

Summary

Repair of myelomeningocele is a surgical procedure to correct a birth defect where a baby's spinal cord and the surrounding tissues form outside the body. The procedure involves surgically closing the defect to prevent infection and further complications.

Purpose

The procedure addresses the medical condition known as myelomeningocele, a severe form of spina bifida. The goal is to protect the spinal cord and nerves, prevent infection, and improve the overall neurological outcomes and quality of life for the patient.

Indications

• Presence of a myelomeningocele larger than 5 cm in diameter
• Symptoms include a visible sac on the baby’s back at birth, potential paralysis, bowel and bladder dysfunction, and possible hydrocephalus
• Indicated for newborns diagnosed with this condition to prevent further complications

Preparation

• Pre-procedure instructions may include fasting for a specified period
• Diagnostic imaging such as MRI or ultrasound to assess the defect
• Blood tests to check for any other potential health concerns
• Discussing anesthesia options and potential risks with the parents or guardians

Procedure Description

1. The patient is placed under general anesthesia.
2. The affected area is carefully prepared and disinfected.
3. An incision is made around the myelomeningocele sac.
4. The spinal cord and nerves are placed back inside the spinal canal.
5. The defect is closed with layers of sutures, and a skin flap may be used to cover the area.
6. The area is then covered with a sterile dressing to prevent infection.

Tools and Equipment:

• Surgical scalpels, forceps, and scissors
• Sutures and skin flaps
• Anesthesia equipment Anesthesia Details:
• General anesthesia is administered for the duration of the procedure.

Duration

Typically, the procedure takes about 2 to 4 hours, depending on the complexity of the defect.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Pediatric neurosurgeon
• Anesthesiologist
• Surgical nurses
• Pediatricians for post-operative care

Risks and Complications

Common risks:

• Infection
• Bleeding
• Wound dehiscence (breakdown) Rare risks:
• Neurological deficit
• Cerebrospinal fluid leakage
• Hydrocephalus requiring further surgery Complications management:
• Antibiotic therapy for infection
• Further surgical intervention if necessary

Benefits

The primary benefits include:

• Protection of the spinal cord and nerves
• Prevention of infections
• Potential improvement in neurological function Benefits can often be realized immediately post-surgery with continued improvement over time.

Recovery

• Post-procedure care includes wound care, monitoring for infection, and pain management.
• Initial hospital stay may last 7 to 10 days.
• Full recovery can take several weeks, with activity restrictions to prevent strain on the surgical area.
• Follow-up appointments with the surgical team and physical therapy may be required.

Alternatives

Other treatment options:

• Prenatal surgery to correct the defect before birth
• Conservative management including physical therapy and braces, though these might not address the underlying defect Pros and Cons:
• Prenatal surgery has higher risks but potentially better neurological outcomes.
• Conservative management reduces surgical risks but may not prevent further neurological damage.

Patient Experience

• The patient, being a newborn, will be under general anesthesia during the procedure and hence will not feel pain during the surgery.
• Post-operative care will focus on comfort, pain management, and monitoring for any signs of complications.
• Parents or guardians might notice improvements soon after the procedure, but long-term progress will vary depending on the severity of the initial condition.