CONGENITAL MENINGOCELE & HYDROCEPHALUS, WHEN TO OPERATE IN ONE OR TWO SESSIONS

Aim To know what cases operated upon in one session rather than two sessions for neonates with congenital meningocele associated with hydrocephalus. Background A meningomyelocele is common birth defect(0.2-2/1000 live births), defined as 'a hernial protrusion of a part of the meninges and substance of the spinal cord through a defect in the vertebral column' with or without neurological deficit, and 15-25% of neonates with myelomeningocele have hydrocephalus at birth. about 80-90% of them need shunt procedure. meningocele repair and vp shunt placement done in one or two session . Object To compare the result of surgery and complications of meningocele repair and vp shunt placement when done in one or two session .which is best. Materials and Methods This is a comparative prospective study of 30 patients with congenital meningocele and hydrocephalus whatever their presenting status having their defects corrected by surgery, these patients divided into two groups; group one; have their meningocele repair and vp shunt placement done in one session(15 patients).group two; have done in two sessions(15 patients). These patients were selected randomly. We observed and analysed the presenting features , age and complications for these infants underwent surgeries in one and two sessions to know what criteria drive our decision to operate in one or two sessions. Results We find 10 neonates from one session group operated between days 1-5 while no neonates from two sessions group. and 3 neonates from one session group operated from days 6-10 while 2 neonates from two sessions group. and 3 patients from two sessions group operated up to one year while no patient in one session group. Only two of one session group move their lower limbs versus 10 patients in two sessions group. Eleven out of 15 have ruptured meningocele in one session group versus 4 out of 15 in two sessions group have ruptured meningocele. Seven neonates from one session group were underweight versus 2 from two sessions group. Tow neonates from one session group stayed for 3-5 days versus 8 neonates from two sessions group. Five neonates from one session group stayed for 11-15 days versus 3 neonates from 2 sessions group. CSF leak &wound dehiscence, Chest infection, Wound infection, Jaundice, Poor feeding& Death due to septicemiamore occur in neonates of one session group versus neonates of 2 sessions group. Moreover, primary neurosurgical repair of meningocele within the first 72hours after delivery provides an improved neurogenic bladder/bowel prognosis