NEUROSURGICAL TECHNIQUES FOR MENINGOMYELOCELE REPAIR: A LITERATURE REVIEW (Atena Editora)

Abstract

Introduction: Myelomeningocele (MMC), resulting from alterations in neural tube closure during embryonic life, is the most severe form of spina bifida. MMC is diagnosed through morphological ultrasound between the 18th and 22nd gestational week through direct visualization of the dorsal malformation. With the emergence of fetal medicine, early treatment of MMC became possible and its prognosis more satisfactory. Goal: To understand the feasibility of neurosurgical techniques for meningomyelocele repair and post-surgical effects. Method: Bibliographic review carried out in April 2021 at the Virtual Health Library. The descriptors used, defined by DeCS/MeSH, were “meningomielocele” AND “surgery”. Articles published between 2016 and 2021, in all languages, were considered. By reading the titles, abstracts, eliminating duplicates and including articles manually selected for the relevance of the theme, original articles were chosen to compose this review article. Results: Early separation of the spinal cord with amniotic fluid can prevent major neurological damage to the patient. Prenatal surgery lessens the occurrence of tonsillar herniation and hydrocephalus. In cases of deformities secondary to MMC, fusion surgery instrumented by constructions of pedicle nails and screws promotes improvement in the neurological and functional status and correction of spinal angulation. The island flap technique based on perforating arteries (KDPIF), performed after birth, enables adequate vascularization of the tissue, preventing future deformities and necrosis of the skin flap. Fetal surgery proved to be more effective than postnatal surgery because it represents a possibility of fetal development of the nervous system closer to what is considered normal, reducing the need for a shunt and promoting a better urological prognosis. However, it has limitations because it poses risks to the mother and fetus. Conclusion: Post-birth surgery entails prolonged contact with amniotic fluid. Thus, when comparing pre and postnatal surgery, it is clear that intrauterine surgery has greater advantages by providing repair in a timely manner so that there is a better quality of life for the patient with MMC.