Ruptured Meningomyeloceleの早期積極的神経保存手術とその成績

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The surgical attitude has changed over the few years to a more active approach, because early closure of ruptured meningomyelocele appear to have prevented the death and decrease the occurence of disability But, long term results of early operation of infants born with ruptured meningomyelocele are disapointing in spite of an immense effort to minimize their handicaps. Although it is indicated that the improvement of early operation does not lead to fewer, but to more, handicapped children, authors have recently applied microsurgical technique and electrical stimulation at the early stage operation (8-24 hours after birth) as described detail in this paper. Thirty cases are selected by the criteria shown in Fig. 1 for candidate of operative treatment. Sixteen cases of them are treated by microsurgical operation at early stage and other 14 cases are treated by conventional operative method. On the both group, the clinical evaluation about occurence of hydrocephalus, disturbance of bladder and sphincter control and motor activity of the lower extremities are comparatively done at pre and 6-14 months after operation. The outcomes following the early microsurgical operation described in this paper are as follow; 1) there is no operative mortality, 2) 33% of all cases can walk and 42% can stand up without any help, 3) sphincter function is normalized in 50% of all cases, Rectanal reflex changes to normal response in 40% of all cases, 4) bladder function becomes normal in 64% and its recovery is not always related with recovery from disturbance of anal reflex nor motor function, 5) but the incidence of hydrocephalus following the operation is almost same as that of conventionally operated cases. It might be concluded that the early operation to preserve functioning exposed neural tissue by using microscope and electrical stimulation us a better treatment for the ruptured meningomyelocele.
日本脳神経外科学会の論文

Ruptured Meningomyeloceleの早期積極的神経保存手術とその成績

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