RESUMEN
PURPOSE: The aim of this study is to evaluate the effect of division of the tethered spinal cord urodynamically in spinal dysraphic cases. METHODS: Between 1995-1997, 20 cases (11 males, 9 females) aged from 5 months to 13 years with TSC were investigated. 13 cases (65%) were classed as belonging to the myelomeningocele group and 5 cases (35%) to the spina bifida occulta group. We used a computerized urodynamic system to evaluate the functions of the lower urinary tracts pre- and postoperatively. The definitive diagnosis of cord tethering was made using magnetic resonance imaging (MRI) in 19 cases (95%) and spinal ultrasound in 1 case (5%). Division of filum terminale and laminectomy were carried out in all cases by the Neurosurgery Department, and 2 cases with retethering were operated on twice. RESULTS: All of these cases were assessed urodynamically in the preoperative and postoperative period. Significant improvements were noted in detrusor functions (35%); electromyography recordings (45%); high leak point pressures (55%) and anal and urinary continence (70%). CONCLUSION: Lower urinary tract dysfunctions secondary to tethered cord syndrome are very common in spinal dysraphic cases and significant improvements can be achieved with a judiciously timed division of the spinal tethered cord.
Asunto(s)
Meningomielocele/fisiopatología , Espina Bífida Oculta/fisiopatología , Enfermedades de la Médula Espinal/fisiopatología , Médula Espinal/cirugía , Urodinámica , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Meningomielocele/complicaciones , Meningomielocele/cirugía , Estudios Retrospectivos , Espina Bífida Oculta/complicaciones , Espina Bífida Oculta/cirugía , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugíaRESUMEN
Seventy-five patients with intracranial hypertension whose Glasgow Coma Score (GCS) was 8 or below and in whom intracranial pressure (ICP) was monitored were examined for complications of this procedure. In 20 of the 75 patients we used only an intraparenchymal fiberoptic ICP monitoring transducer, while, in the remaining 55 patients, who required CSF drainage, a ventricular drainage set (VDS) was used in addition to ICP monitoring. The duration of monitoring with the ICP transducer alone was approximately 5.1+/-2.6 das (min. 1, max. 13) and that of ICP monitoring with VDS was 6.2+/-3.1 days (min. 1, max. 13). In 8 cases a total of 9 complications were experienced (12%). These complications were infection in 3 cases (4%), epidural hematoma in 2 cases (2.7%), disconnection in 2 cases (2.7%) and contusion in 2 cases (2.7%). Although none of the 44 patients who were monitored for less than 5 days experienced infection, 3 of the 31 patients monitored for longer than 5 days did experience infection (9.7%) (p<0.05). None of the 20 patients who underwent ICP monitoring only experienced infection. However, 3 of the 55 patients in whom the ventricular drainage set was implanted in addition to the transducer for ICP monitoring experienced infection (p<0.05). Owing to its minimally invasive nature, low complication rate, and accuracy in monitoring the parenchyma pressure, the Camino fiberoptic intraparenchymal monitor has become the system of choice in our clinic.