Perioperative Anaesthetic Challenges in a Case of Lumbosacral Meningomyelocele: A Case Report

Meningomyelocele is a congenital neural tube defect caused due to incomplete closure of the neural tube during foetal development. In meningomyelocele, a sac is formed due to herniation of the neural tissues and cerebrospinal fluid through defective vertebral arches and is covered by a thin membrane. It produces paraplegia, hydrocephalus, urinary incontinence and higher mental function impairment. It is almost always associated with Arnold Chiari type 2 malformations, wherein there is cerebellar herniation. It is prevalent in developing countries due to non-compliant prenatal care. Proper folic acid supplementation throughout pregnancy helps prevent these neural tube defects. But owing to various socio-economic concerns, that is usually not the case. Paediatric anaesthesia can be a challenging task as they have various anatomical and physiological differences from adults. Proper counselling and explanation play a crucial role in meningomyelocele repair surgeries, especially in the paediatric age group. So many patients end up having post-neurological sequelae if not intervened at the right time. Sometimes, meningomyelocele repair surgeries can be done in the prenatal period as either an open or a foetoscopy approach. This case report is about a 15-day-old neonate with lumbosacral meningomyelocele associated with Arnold Chiari type 2 malformation, a soft palate cleft and a small atrial septal defect posted for meningomyelocele repair surgery. The presence of a cleft palate made it a case of an anticipated difficult airway and with Atrial Septal Defect (ASD), strict hemodynamic control had to be maintained throughout the surgery.