Purpose

Meningomyelocele is a serious pathology that requires immediate surgical treatment. Its management is difficult due to accompanying other pathologies and hydrocephalus. Shunt timing is still controversial. Therefore, this study retrospectively assessed 80 patients in order to improve the shunt timing and management of patients with meningomyelocele.

Methods

A total of 80 patients were followed up for 18–48 (average, 23) months. Patients were analyzed for the following variables: delivery method and time, head circumference monitoring, shunt timing, complication rates of patients who underwent shunting, during the early or follow-up period, accompanying pathologies, size, and localization of lesion.

Results

Patients including 46 males and 34 females have been operated. In 40% of patients, the accompanying pathology was determined. Approximately 85% of patients had hydrocephalus, and a ventriculoperitoneal shunt was placed on 36 symptomatic and 22 patients with hydrocephalus that developed during the follow-up. Differences in shunt-related and general complications were not significant between patients who underwent shunt placement during the same session and patients who underwent shunt placement during the follow-up. However, the incidence of cerebrospinal fluid fistula formation from the wound in patients who underwent shunt placement during the same session was significantly lower than those who underwent shunt placement during follow-up.

Conclusions

Immediate surgery (within the first 48 h) provides positive results, which is consistent with the existing literature. According to the logistic regression analysis, the placement of the meningomyelocele sac in the lumbosacral region is decisive in shunt insertion. Placing the shunt in the same session for patients with hydrocephalus and later for patients who developed hydrocephalus during the follow-up is recommended as a favorable treatment.

中文翻译：

---

脊髓脊膜膨出分流时机及临床结果：附 80 例分析。

目的

脊髓脊膜膨出是一种严重的疾病，需要立即进行手术治疗。由于伴随其他病理和脑积水，其管理很困难。分流时间仍然存在争议。因此，本研究回顾性评估了 80 例患者，以改善脑膜脊髓膨出患者的分流时机和管理。

方法

总共对 80 名患者进行了 18-48（平均 23）个月的随访。分析患者的以下变量：分娩方法和时间、头围监测、分流时间、接受分流的患者的并发症发生率、早期或随访期间、伴随的病理、大小和病变的定位。

结果

手术患者包括男性46例，女性34例。在 40% 的患者中，确定了伴随的病理学。大约 85% 的患者有脑积水，在随访期间对 36 名有症状的脑积水患者和 22 名脑积水患者进行了脑室腹腔分流术。在同一疗程中接受分流术的患者与在随访期间接受分流术的患者之间，分流相关并发症和一般并发症的差异不显着。然而，在同一疗程中接受分流术的患者伤口形成脑脊液瘘的发生率明显低于随访期间接受分流术的患者。

结论

立即手术（前 48 小时内）提供了积极的结果，这与现有文献一致。根据logistic回归分析，腰骶部脑膜脊髓膨出囊的位置对分流术的置入起决定性作用。建议对脑积水患者和随后在随访期间出现脑积水的患者在同一疗程中放置分流管作为有利的治疗方法。