Abstract
MeningoMyeloCele (MMC) is a complex congenital spinal anomaly resulting from neural tube defect during first 4 weeks of gestation. Early surgery within 48 hours of birth should be performed to prevent rupture, infection, tethering and its sequelae.
Approach to anesthesia is multifold, proper position to protect the rupture of thin walled sac when supine, and position to secure the airway and avoid compression of cervical cord due to ACM, intraoperative blood loss and temperature management.
We report a case of 6 month, 7 kg child of MMC with ACM with hydrocephalus and bilateral congenital CTEV with a head circumference of 49 cms, and an enlarging and discharging MMC sac.
Keywords: MMC, 6 months, hydrocephalus, ACM, Position, Venous access, Hypothermia.
References
- Charles lee, Igor luginbuehl, Bruno bissonnette, Linda j.mason. pediatric diseases in: Roberta L.Hines, Catherine marshall, editor. Stoelting „s Anaesthesia and coexisting diseases 5 th edition. Elsevier Churchill livingstone; 2008 pg: 608- 609
- Charles J.cote. Pediatric anesthesia in: Ronald D Miller, editor. Millers anesthesia 6th edition; Elsevier Churchill livingstone; 2005, pg2395..
- John HM, Haervey BS, Laura FS. Malformation of the central nervous system. J. Child neurology 2006 ;285-366
- Rinaldi F, Cioffi FA, Columbano L, Krasagakis G, Bernini FP, Tethered cord syndrome. Journal of neurosurgical science 2005; 49: 131-5
- Soriano SG, McManu ML. Pediatric neuroanesthesia and critical care. In: Cottrell JE, Young WL, editors. Cottrell and Young's Neuroanesthesia. Philadelphia: Mosby Elsevier; 2010. pp. 327–42.
- Singh D, Rath GP, Dash HH, Bithal PK. Anesthetic concerns and perioperative complications in repair of myelomeningo-cele: A retrospective review of 135 cases. J Neurosurg Anesthesiol. 2010;22:11–5.
- Herman JM, McloneStors BB, Dauser RC. Analysis of 153 patients with myelomeningocele or spinal lipoma are operated upon for a tethered cord : presentation, management and outcome. Pediatric neurosurgery 1998;19:243-249-327
- Oren J, Kelly DH, Todres ID. Respiratory complications in pateitns with myelodysplasia and Arnold Chiari malformation. Am. J. Dischild 1986;140:221-224.
- Elliot J. Krane, Bridget M. Philip, Kelly K.yeh, Karen B.Domino, Anesthesia for pediatric neurosurgery in: Etsurok. Motoyamma and Peter J.Davis, editors: Smith‟sanaesthesia for infants and children, 7 th edition: mosby: 2005.
- Chand MB ,Agarwal J , Dr P.Bista. Anaesthetic challeneges and management of myelomeningocele repair.PMJN(Post graduate medical journal of NAMS) Volume 11, Number 1, Jan-June 2011.
Corresponding Author
Dr Daga Khushboo, MD Anaesthesia
Resident, Bombay Hospital, Institute of Medical Sciences, Mumbai, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.131
