Experience of Ruptured Thoracolumbar Myelomeningocele Repair Under Local Anesthesia in Neonates

Objective: To see the efficacy of surgical repair of ruptured thoracolumbar myelomeningocele under local anesthesia. Study Design: Quasi experimental study. Place and Duration of Study: Neurosurgery center, CMH Rawalpindi, Pakistan from Jun 2022 to Jan 2024. Methodology: All the patients were operated within 24 hours of presentation to the hospital. All the patients were neonates, having ruptured Thoracolumbar Myelomeningocele sac, with established complete or incomplete neurological deficit. The cases with intact neurology, cervical and upper thoracic vertebral levels, severe or un-diagnosed coagulopathy were excluded from the study. Parents were counselled in detail about the purpose of the surgical procedure being to prevent future complications of ruptured myelomeningocele; and established neurological deficit shall not be reversed. Results: Out of the 50 children, with male pre-ponderance, 17 were paraplegic and 33 were paraparetic. Surgical site infection, post repair hydrocephalus, cerebrospinal fluid leak and meningitis were seen in 8%, 38%, 10% and 4 % of the participants, respectively. No patients developed any local anesthesia systemic toxicity. 6% patients developed wound dehiscence resulting in re-admission. The mean hospitalization stay was 3.5±2.0 days, while mean operative time was approximately 40 minutes. Mean blood loss was 35.8±7.04 ml, while mean transfusion was 21.38±6.49ml. Mean follow-up time was 6.7±1.6 days. 2(4%) patients lost to follow-up. One patient died before discharge. Conclusion: The repair of ruptured Thoracolumbar Myelomeningocele under local anesthesia, is an efficient, convenient, cost effective and feasible surgical approach for resource constrained settings with high patient burden.