Meningomyelocele and Anesthesia
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Meningomyelocele is a neural tube defect affecting 1 in 1000 births where the meninges and neural components protrude through the spine. It most commonly occurs in the lumbar or sacral region. Associated conditions include orthopedic problems, urological issues, and Arnold Chiari malformation. Prenatal diagnosis is possible using ultrasound and biochemical tests. Surgical closure is typically performed within 24 hours to reduce neurological deficits, along with shunt placement if hydrocephalus develops. Perioperative care focuses on infection prevention and hemodynamic stability, with postoperative monitoring for complications like respiratory distress, apnea, or hydrocephalus symptoms.
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This document discusses the anaesthetic management of patients with meningomyelocele. Key points include:
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Ntd
This document discusses neural tube defects (NTDs), which are birth defects where an opening remains in the spine or skull early in development. The main types are open defects like spina bifida and anencephaly, and closed defects. NTDs can be caused by folic acid deficiency, genetics, medications, and other factors. Symptoms vary depending on the specific defect. Diagnosis may involve ultrasounds and alpha-fetoprotein testing. Treatment ranges from surgery to palliative care, while prevention focuses on adequate folic acid intake before and during pregnancy.
spinabifida-200601103727.pdf
Spina bifida is a birth defect where the spinal cord fails to close properly, leaving it exposed. There are three main types: spina bifida occulta, which has no protrusion and is usually asymptomatic; meningocele, which involves protrusion of meninges and cerebrospinal fluid in a sac; and myelomeningocele, the most severe form, which involves protrusion of spinal cord and nerves. Treatment involves surgery to close the defect as well as management of any related conditions like hydrocephalus or paralysis. Parents are counseled and trained to care for the child's lifelong needs.
Spina bifida
Spina bifida is a birth defect where the spinal cord fails to close properly, leaving it exposed. There are three main types: spina bifida occulta, which has no protrusion and is usually asymptomatic; meningocele, which involves protrusion of meninges and cerebrospinal fluid in a sac; and myelomeningocele, the most severe form, which involves protrusion of meninges, spinal cord, and cerebrospinal fluid. Treatment involves surgery to close the defect as well as management of any related conditions like hydrocephalus or paralysis. Parents are counseled and trained to care for the child's lifelong medical needs.
Neural tube defects
This document discusses neural tube defects, which result from failure of the neural tube to close during early development. It describes the classification, diagnosis, investigations, management, and prevention of various neural tube defects including anencephaly, encephalocele, spina bifida, meningocele, and myelomeningocele. Prenatal screening and folic acid supplementation are important for prevention, while management requires a multidisciplinary approach to address physical, developmental, and cognitive issues.
Birth injury
Birth injury has to be prevented by health care personals because a healthy newborn should not lose his / her healthy life because of minor problems.
birth injuries.pptx
Birth injuries can occur during difficult labor and delivery and may cause neonatal death or morbidities. Risk factors for birth injuries include large baby size, cephalopelvic disproportion, difficult labor, abnormal fetal position like breech, and instrumental delivery. Common birth injuries affect the head and brain (intracranial hemorrhage), facial nerves (facial paralysis), brachial plexus (Erb's palsy), and neck muscles (torticollis). Prevention involves early detection of risk factors and managing labor appropriately to avoid trauma to the baby.
Neural tube defect
This document provides an overview of neural tube defects (NTDs), which are among the most common birth defects. It discusses the embryology, causes, types (including anencephaly and spina bifida), clinical presentation, diagnostic tests (such as ultrasound and MRI), and management (including prenatal surgery, medical care of newborns, and post-natal surgical repair). Key points covered include the importance of folic acid supplementation to prevent NTDs, the variety of potential genetic and environmental risk factors, and ongoing areas of research and debate around improving treatment and outcomes.
Neural tube defects (myelomeningocele) | spina bifida
Neural tube defects occur when the neural tube fails to close properly during early embryonic development. This document discusses several types of neural tube defects including anencephaly, myelomeningocele (spina bifida), and meningocele. It covers the pathophysiology, clinical presentation, diagnostic evaluation, management including surgical repair, and long term prognosis of those affected. Prevention through adequate folic acid intake before and during early pregnancy is also discussed.
Encephaloceles
Encephaloceles are rare birth defects associated with skull defects characterized by partial lacking of bone fusion leaving a gap through which a portion of the brain sticks out (protrudes).
Isolated Intracranial Hydatid Cyst - Multidisplinary Approach
This document describes the case of a 13-year-old boy who presented with a one month history of progressive headaches, left-sided weakness, and mild bilateral papilledema. Imaging revealed a cystic lesion in the right parieto-occipital region. The patient underwent a neurosurgical procedure to remove the intact cyst, which was confirmed to be an isolated intracranial hydatid cyst based on pathology. Hydatid cysts are caused by the tapeworm Echinococcus and most commonly involve the liver and lungs. Intracranial involvement is rare but can cause signs of increased intracranial pressure like this case.
Neonatal head usg
Neonatal cranial sonography is an important tool for evaluating infants with suspected brain abnormalities. It can detect hemorrhages, hydrocephalus, hypoxic ischemic injury, infections, and congenital anomalies. USG is rapid, portable, and avoids radiation, making it well-suited for neonatal intensive care. The summary outlines key findings on USG like germinal matrix hemorrhage, periventricular leukomalacia, hydranencephaly, and how to evaluate features of hydrocephalus. USG is also discussed as the initial study for complications of conditions like TORCH infections and hypoxic ischemic encephalopathy.
HYDROCEPHALUS (2)222.ppt
Hydrocephalus is a condition caused by an imbalance in cerebrospinal fluid circulation and absorption in the brain, which leads to excessive accumulation of fluid in the ventricles and increased intracranial pressure. It can be congenital due to malformations or acquired from infections, tumors, or hemorrhages. The excess fluid causes ventricle dilation and brain compression. Treatment involves surgical placement of a shunt to drain fluid from the ventricles to the abdominal cavity or heart. Complications include shunt malfunction and infection. Spina bifida is a neural tube defect where the spine fails to close, often with a visible sac-like protrusion of membranes and spinal cord. It can cause paralysis, in
Spina Bifida (2).pptx2222222222222222222
Spina bifida is a birth disorder that involves the incomplete development of the spine. In the first month of pregnancy, a special set of cells forms the “neural tube;” the top of the tube becomes the brain, and the remainder becomes the spinal cord and structures around it. In spina bifida, the neural tube doesn’t close completely and some of the bones of the spine do not close in the back. This can result in an opening anywhere along the spine and may cause damage to the spinal cord and nerves.There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. The symptoms of spina bifida vary from person to person, depending on the type and level of involvement. Most cases are mild and do not require special treatment. The more serious cases involve nerve damage.
Occulta is the mildest and most common form in which one or more bones of the spinal column (vertebrae) are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the opening in the bones of the spine. It usually shows no symptoms and is often found by accident on an x-ray or similar test.
Closed neural tube defects are a diverse group of disorders in which the spine may have malformations of fat, bone, or the membranes (the meninges) that cover the spinal cord. Many of these neural tube defects require surgery in childhood. People with this type of spina bifida may have weakness of the legs and trouble with bowel and bladder control. These issues may change or progress as children grow. It is important to have close communication with doctors to minimize these changes as much as possible.
Meningocele occurs when the meninges protrude through the spine and cause a sac of spinal fluid on the back. This fluid is typically only around the brain and spine, but a problem with the bony covering over the spine allows it to poke out. The malformation contains no nerves and may or may not be covered by a layer of skin. Individuals with meningocele may have minor symptoms.Myelomeningocele is the most severe form of spina bifida. A portion of the spinal cord or nerves are exposed in a sac through an opening in the spine that may or may not be covered by the meninges. The opening can be closed surgically while the baby is in utero or shortly after the baby is born. Most people with myelomeningocele experience changes in brain structure, leg weakness, and bladder and bowel dysfunction.
Myelomeningocele is often called a "snowflake condition" because no two people with the condition are the same. Typically, if the opening in the spine is lower down the back, the person will experience less symptoms. People with myelomeningocele require close follow-up with physicians throughout their childhood and lifespan to maximize their function and prevent complications like kidney failure.Complications of spina bifida may include:
Abnormal sensation or paralysis, which mostly occurs with closed neural tube defects and myelomenin
Birth injuries.P
"Birth Injuries" Generally due to 'Tremendous Pressure' put up on while passing through the 'birth Cana'.
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2. Imperforate anus can be associated with other birth defects, including vertebral, anal, cardiac, tracheo-esophageal, renal, and limb defects. Lesions can be high or low. High lesions require a colostomy before repair surgery while low lesions can be repaired via a perineal anoplasty.
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Meningomyelocele and Anesthesia
- 2. Meningomyelocele • Incidence: 1 in 1000 live births • Most common congenital primary neural defect Meningo: involving the meninges Dura Arachnoid Myelocele: involving the neural components Neural placode Nerve tissue roots CSF Components of a meningomyelocele
- 3. Embryology Neural tube development-failure of closure of neural tube causes a meningomyelocele
- 4. Embryology…….(contd) It presents most commonly over the lumbar, sacral vertebra as a cystic mass
- 5. Meningomyelocele •Coexistent morbidities: Orthopedic problems in the child Urologic complications • Antenatal diagnosis Ultrasonography biochemical tests: α fetoprotein levels in the maternal serum and amniotic fluid
- 6. Associated Conditions-Arnold Chiari Malformation •Brain stem anomaly •Caudal displacement of Cerebellar vermis Medulla oblongata Cervical spine Kinking of the medulla Obliteration of cisternamagna • Clinical presentation Stridor, Apnea, bradycardia aspiration pneumonia sleep disordered breathing pattern vocal cord paralysis Lack of co-ordination & spasticity
- 7. Associated Conditions-Arnold Chiari Malformation….(contd) • small sized skull housing a normal sized posterior fossa Approach to a meningomyelocele patient…. • To operate within 24 hours-reduces the neurological deficits • Close the defect and place a shunt • or delay placing a shunt and instead operate once hydrocephalus sets in • Intra uterine procedure is less favoured • Posterior fossa decompression should always be a last resort
- 8. Meningomyelocele-preoperative care •An exposed neural placode risks Trauma Continous CSF leakage-countered by full strength balanced salt solution place a soaked gauze to prevent desiccation Maintain extracellular fluid Avoid hypothermia
- 9. Meningomyelocele-Peri operative care Anesthetic technique 1. Positioning: Supine: the defect ought to rest in a “doughnut” to minimise trauma. Lateral: leads to difficult intubation Prone: Care is taken to avoid pressure on epidural venous plexus to maintain bleeding and allow adequate ventilation. 2. The child usually has an IV cannula in place with maintenance fluids. 3. Premedication—atropine 20 mcg/kg IV prior to induction if desired. 4. Induction is IV or inhalational as preferred. The child may need to be supported on a cushion or jelly ring to avoid pressure on the lesion or placed in the lateral or semi-lateral position depending on the exact anatomy.
- 10. Meningomyelocele-Peri operative care Anesthetic technique 5. Endotracheal intubation with an armoured ETT and IPPV are required. 6. Maintenance is with volatile agents in oxygen and air or nitrous oxide. 7. Consider arterial and central line depending on the size of the lesion. 8. The patient is positioned prone for surgery. Rolls of soft material or jelly bolsters are placed under the shoulders and pelvis to allow free abdominal movement during ventilation. 9. The extremities are padded. 10.The surgeon may wish to stimulate nerves during the procedure. Discuss this before giving a long acting neuromuscular blocker. 11.Blood loss is not usually a problem but some large lesions require extensive undermining of skin to fashion a flap or flaps when bleeding does become an issue.
- 11. Meningomyelocele-Peri operative care Anesthetic technique 12.The surgical site is usually infiltrated with LA and adrenaline to ensure haemostasis. Additional opioid analgesia (morphine sulphate 25-50 mcg/kg or fentanyl citrate 1-2 mcg/kg) can be given if this is inadequate. The sensory level is usually unclear at this point so analgesic requirements are variable. 13.IV antibiotics are given according to surgical request or local protocol. 14.If stable, extubate at the end of procedure.
- 12. Meningomyelocele-Post-operative care Watch out for • Stridor • Apnea • Bradycardia • Cyanosis • Respiratory arrest Secondary to brain stem herniation If shunting is not done, then watch out for symptoms associated with hydrocephalus •Lethargy •Vomiting •Seizures •Apnea •Bradycardia •Cardiovascular instability. If symptoms worsen, proceed with shunting