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[Current problems of the treatment of spina bifida aperta]
Insights
Early surgical intervention for spina bifida aperta is crucial to prevent fatal infectious complications. Modern treatments significantly reduce postoperative mortality in affected children.
Area of Science:
- Pediatric Surgery
- Neurology
- Developmental Biology
Context:
- Spina bifida aperta is a complex congenital condition requiring specialized surgical and medical management.
- Infectious complications pose a significant threat to survival in neonates undergoing surgical repair.
- Arnold-Chiari malformation is frequently associated with congenital hydrocephalus in affected infants.
Purpose:
- To review the authors' experience in managing 311 children with spina bifida aperta.
- To highlight the risks of infectious complications and their impact on mortality.
- To discuss the optimal management strategies for associated internal hydrocephalus.
Summary:
- Experience with 311 children with spina bifida aperta indicates that early surgery (within 2 days of birth before epithelization) increases the risk of infectious complications and mortality.
- Internal hydrocephalus, often linked to Arnold-Chiari malformation, is best managed with ventriculoatrial or ventriculoperitoneal shunting; spinal draining is not recommended.
- Recent advancements have reduced the postoperative mortality rate for spina bifida aperta to 3%.
Impact:
- Improved understanding of the critical timing for surgical intervention in spina bifida aperta to minimize infectious risks.
- Refined management protocols for hydrocephalus in spina bifida aperta patients, emphasizing shunting over spinal drainage.
- Demonstrated significant reduction in mortality rates, reflecting progress in pediatric surgical care for this condition.
Abstract:
Experience in the treatment of 311 children with spina bifida aperta is generalized. The authors emphasize the hazard of infectious complications, which were the cause of death of 26.3% of children who were operated on 2 days after birth and before epithelization of the meningeal cavity. Internal hydrocephalus is congenital and linked etiopathogenetically with the Arnold-Chiari malformation. Treatment of internal hydrocephalus consists in ventriculoatrial and ventriculoperitoneal shunting. Spinal draining operations are not recommended. Postoperative mortality in spina bifida aperta has reduced to 3% in the recent years.