Spina bifida - Treatment

Surgical therapy:Closing defect immediately after birth if it is present in the formation and leakage of lighid in the first 24-48 hours in the absence of the leak. The surgery can be delayed several days without additional morbidity and mortality. Skin defect closing steps include extensive subversion, dissection of neural plate is relocated into the spinal canal and meticulous closure of the dura, skin and subcutaneous fascia.
Perioperative complications include wound infection, brain infection, delayed wound healing, cerebrospinal fluid leakage, hidrocefalus infarction. Seven long-term complications include spinal and hidrocefalus progressive.Although hidrocefalusul stops spontaneously in some cases, 90% of children with spina bifida require bridging. Ventriculoperitoneal shunting is the preferred method. Alternatives include ventriculoatriala and ventriculopleurala shunting. Perioperative complications include hemorrhage, intestinal perforation and infection. Long-term complications include shunt obstruction, infection or excessive drainage.
Orthopedic Therapy:Orthopaedic interventions are directed to soothe functional.Progressive spinal deformities and scoliosis require spinal stabilization. Spinal orthopedic devices serve as a temporary treatment but growing children with curvatures over 35 degrees require spinal fusion surgery. Muscle and joint contractures require tenotomii and tendon releases to wear the cast later.Fetal Surgery:There are studies of performing fetal surgery to evaluate the safety and effectiveness of these interventions. This surgery involves opening the mother's abdomen and uterus to operate on the fetus.This access route is called open fetal surgery. Fetal skin grafts are used to cover the exposed spinal cord, injuries to prosthesis lighidul prolonged exposure to amniotic fluid. Fetal surgery may reduce some adverse effects of spina bifida but subject to risk pregnant and the fetus.
In response to open fetal surgery has developed a mini invasive technique. This approach uses three trocars Minin invasive than the external diameter of 5 mm placed through punctures in the abdominal wall, breast and uterus. The unborn can be manipulated this way and closed the defect with small instruments. Approach fetoscopic TRUMA cause minor mother and does not require surgical opening of the abdomen and uterus.
Prognosis:Aggressive therapy with closure in the neonatal period leads to survival in most cases of spina bifida. Maintaining an intelligent bridging allows hidrocefalusului cvasinormale. Ependent ambulatiei prognosis is affected by the lesion and quadriceps. If flexion contractures and deformities are severe spinal reflexes of patients without using Cirja MEMBER can go lower. Longevity is dependent on renal function and the integration of a compliance regime for bladder and colon. Long-term survival in childhood and up to advanced ages is common today with aggressive treatment.