PROTOCOL FOR REPAIR OF LATE PRESENTATION OF MYELOMENINGOCELE – INITIAL STUDY

Abstract

ABSTRACT:- Background: - The incidence of myelomeningocele is on the wane in view of ready access to medical facilities and a well organized ANC check up, however in families located far away in the interiors regular ANC is not done leading to surprises during the delivery. MMC and its associated disabilities after treatment require special care and commitment from the parents. All this adds additional responsibilities on the parents; therefore it is not unusual for the parents to refuse surgery. We came across few parents who refused surgery initially but returned at various intervals of time for management. Methods: - Command Hospital Central Command had a sudden spurt of MMC cases in which 5 patients presented late after initially refusing surgery. All of them had associated ACM II with hydrocephalus, 02 had evidence of local infection on the sac, 01 patient had evidence of meningitis. There was one fatality. All the patients underwent upfront VP shunt followed by repair of the defect after cultures from the wound showed negative growth Conclusion: - The management of MMC is quite straight forward if presented at birth, the protocols are well laid out, however our institute had a situation where 05patients presented after initially refusing surgery, there are not many definitive protocols addressing this particular situation. However a planned protocol addressing all possible issues has led to a favorable outcome. We hereby present our initial experience of management of late presentation of myelomeningocele.