1
|
Chen X, Shen W, Han T, He J, Cui J. Closure of Giant Dorsal Lumbosacral Myelomeningocele in Children Using Double Expanded Flaps: A Case Report and Literature Review. J Craniofac Surg 2023; 34:e703-e706. [PMID: 37646332 DOI: 10.1097/scs.0000000000009687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Myelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, expanded flaps can be used for closure of large MMCs. PRESENTATION OF CASE A 4-year and 6-month girl was diagnosed with multiple congenital anomalies including hydrocephalus, dorsal lumbosacral MMC, and congenital tethered cord syndrome. Preoperative evaluation showed no lower limb movements and the size of the sacrococcygeal region was about 10 cm × 8 cm × 15 cm mass, prominent thoracic kyphosis, and no obvious urogenital or limb anomalies. The large dorsal lumbosacral MMC was treated with a double expanded flap to reconstruct, the soft tissue defect following the neurosurgical reconstruction. DISCUSSION The expanded flap was deemed as viable as all wounds were healed without any complications, such as dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers an effective method of closure. CONCLUSION This flap can be an effective method for reconstruction of large dorsal lumbosacral MMC defects that might improve outcomes and minimize complications. It also ensures minimal wound tension and breakdown.
Collapse
Affiliation(s)
- Xin Chen
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University
| | - Weimin Shen
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University
| | - Tao Han
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University
| | - Junping He
- Department of Neurosurgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Cui
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University
| |
Collapse
|
2
|
Bartonek Å, Eriksson M, Ericson A, Reimeringer M, Lidbeck C. Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1056. [PMID: 37371287 DOI: 10.3390/children10061056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.
Collapse
Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Annika Ericson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Mikael Reimeringer
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| |
Collapse
|
3
|
Hosseini-Siyanaki MR, Liu S, Dagra A, Reddy R, Reddy A, Carpenter SL, Khan M, Lucke-Wold B. Surgical Management of Myelomeningocele. NEONATAL 2023; 4:08. [PMID: 38179156 PMCID: PMC10766379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Myelomeningocele (MMC) is one of the most common abnormalities of the central nervous system that causes significant neurological impairment. Traditionally, treatment consisted of postnatal closure with the management of the complications, such as ventricular shunting. MMC is a plausible candidate for in-utero surgery because of the mechanism of neurologic damage that begins with abnormal neurulation and continues throughout gestation. Researchers discussed the benefits of in-utero closure prior to the publication of the prospective randomized multicenter Management of Myelomeningocele Study (MOMS trial). Compared to postnatal repair with maternal complications and prematurity as trade-offs, prenatal repair reduced shunting, reversed hindbrain herniation, and improved neurological function. This article discusses the diagnosis, evaluation, long-term follow-up, surgical options, and innovative treatment for fetal myelomeningocele.
Collapse
Affiliation(s)
| | - Sophie Liu
- Department of Neuroscience, University of Johns Hopkins, Baltimore, MD, USA
| | - Abeer Dagra
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Ramya Reddy
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Akshay Reddy
- University of Florida, College of Medicine, Gainesville, FL, USA
| | | | - Majid Khan
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | | |
Collapse
|
4
|
Doi M, Sakurai Y, Sakamaki D, Tanaka S, Katori N, Uezono S. Ultrasonographic images of spina bifida before obstetric anesthesia: a case series. BMC Anesthesiol 2023; 23:134. [PMID: 37095440 PMCID: PMC10123987 DOI: 10.1186/s12871-023-02101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Spina bifida is a relatively common congenital malformation. As the functional prognosis of patients with spina bifida has improved over time, the number of cases resulting in pregnancy and delivery has increased. Lumbar ultrasonography has become a standard and helpful technique before neuraxial anesthesia. We believe that it might be valuable if we use lumbar ultrasonography to evaluate pregnant women with spina bifida before obstetric anesthesia. CASE PRESENTATION We performed lumbar ultrasonography to evaluate four pregnant women with spina bifida. Patient 1 had no history of surgery. Lumbar radiography before pregnancy showed a bone defect from L5 to the sacrum as a result of incomplete fusion. Magnetic resonance imaging showed a spinal lipoma and a bone defect of the sacrum. Lumbar ultrasonography showed similar findings. We performed general anesthesia for emergency cesarean delivery. Patient 2 underwent surgical repair immediately after birth. Lumbar ultrasonography showed the same bone defect as well as a lipoma beyond the bone defect. We performed general anesthesia for cesarean delivery. Patient 3 had vesicorectal disorders but no prior surgery. Lumbar radiography before pregnancy showed congenital abnormalities such as incomplete fusion, scoliosis, rotation, and a notably small sacrum. Lumbar ultrasonography showed the same bone defect. We performed general anesthesia for cesarean section with no complications. Patient 4 complained of lumbago a few years after her first delivery and received a diagnosis of spina bifida occulta by lumbar radiography, with the incomplete fusion of only the 5th vertebra. Lumbar ultrasonography indicated the same abnormalities. We placed an epidural catheter to avoid the bone abnormality and achieved epidural labor analgesia with no complications. CONCLUSIONS Lumbar ultrasonography shows anatomic structures easily, safely, and consistently, without X-ray exposure or the need for more expensive modalities. It is a helpful technique to explore anatomic structures potentially complicated by spina bifida before anesthetic procedures.
Collapse
Affiliation(s)
- Mayuko Doi
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yasuyoshi Sakurai
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Daisuke Sakamaki
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Soichiro Tanaka
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Nobuyuki Katori
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Shoichi Uezono
- Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| |
Collapse
|