Spina bifida meningocele excision and repair

Spinal column fissure usually manifests as spinous process and lamina defect, accompanied by developmental malformation of vertebral body and intervertebral foramen, with dominant and recessive. Dominant include simple meningocele with no obvious neurological symptoms and spinal meningocele with neurological dysfunction, and congenital tumors such as lipoma, teratoma, and epithelioid cyst. The deformity of the lamina can be limited to one vertebra, and it can also involve several adjacent vertebrae. In severe cases, the lumbar vertebrae and the atlas vertebral lamina are both split. In a few cases, there may be multiple spina bifida in the full length of the spine, or a combination of a half-vertebral body and a scoliosis. A very small number of severe cases are spinal deformities, and more complicated neurological deficits are difficult to treat. Treatment of diseases: brain swelling and meningocele meningocele and meningococcal bulging Indication Spinal split meningoceleectomy is suitable for: 1. The meninges of various parts bulge. 2, rupture of the meningeal sac, cerebrospinal fluid leakage, should be treated as emergency surgery. Contraindications Meningocele with severe hydrocephalus can not be used for meningocele repair. On the basis of the treatment of hydrocephalus, meningocele repair should be performed to avoid the healing of the repaired wound due to the increase of intracranial pressure. Preoperative preparation The skin is cleaned daily from 3 days before surgery to prevent the stool from contaminating the surgical area. Those with abnormal hair should be cleaned. If the meningocele has ruptured and there is cerebrospinal fluid leakage, the skin is disinfected and protected with a sterile dressing to prevent bacterial infection and brain (cho) inflammation. Surgical procedure 1. Incision It depends on the size and shape of the bulging mass. The incision line is marked with gentian violet in advance. Generally, a straight incision or a fusiform incision is used on the spinous process. When making an incision, the suture and repair of the skin must be fully estimated, and the normal skin should be kept as much as possible, and the suture should not be too tight, so as to avoid poor healing of the incision. If the bulging sac is larger, the cerebrospinal fluid should be punctured before the surgical incision, so that the bulging capsule collapses or shrinks, so as to facilitate the operation and perform the excision and repair of the bulging sac. 2, free meningocele After the skin is cut, it is freed from the outside of the side of the capsule wall and separated deep into the bulge neck (base) of the lamina defect, and then swelled and swelled forward and backward. Freeing for one week, the neck is completely exposed. 3, remove the bulging capsule From the side of the bulging sac, the wall of the dural sac is cut open or cut first from the top of the sac. The simple meningocele does not contain nerve tissue. If the neck is smaller, the wall of the capsule can be removed. After suturing, it is also included in the spinal canal. If the neck is relatively large, it should be tightly and continuously sutured after the wall is removed to prevent postoperative cerebrospinal fluid leakage. 4, suture repair muscle layer The paravertebral muscle fascia around the free laminar defect is reinforced by overlapping repair according to the method of plastic repair to prevent bulging after surgery. 5, suture subcutaneous tissue and skin If the bulge is too large or the surface of the skin is thin and scar-like, the excess and abnormal skin should be removed, and the subcutaneous free or transfer flap should be repaired and sutured around the normal skin. The wound generally does not require drainage. 6, pressure dressing wounds. complication 1, acute hydrocephalus Patients with potential hydrocephalus before surgery may develop symptoms of acute hydrocephalus after removal of meningocele. 2, wound infection Often the wound is located in the lumbosacral region and is easily contaminated by feces. Concurrent cerebrospinal meningitis, especially the preoperative bulging sac has collapsed, and there are cerebrospinal fluid leaks. In the treatment, the contaminated dressing should be replaced in time, and antibiotic treatment should be applied.

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