General Session: Pediatric Spine - Hall F

Presented by: J. Arzikulov

Author(s):

J. Arzikulov(1), T. Axmediev(2), M. Axmediev(3)

(1) Tashkent Medical Academy / Republic Research Center of Neurosurgery, Tashkent, Uzbekistan
(2) Tashkent Medical Academy / Republic Research Center of Neurosurgery, Pediatric Surgery, Tashkent, Uzbekistan
(3) Tashkent Medical Academy / Republic Research Center of Neurosurgery, Pediatric Neurosurgery, Tashkent, Uzbekistan

Abstract

Objective: Anomalies in the development of the spinal cord and spine in children not only in isolated form, but also in the form of combined lesions complicated with hydrocephalus have their clinical manifestations and patterns of development. Our survey aimed to improve the results of surgical treatment of children with congenital cerebrospinal hernia, with hydrocephalus.

Methods: Research included 120 children of early age with spinal hernia (SH), combined with hydrocephalus. Congenital SH in children were mainly localized in lumbar - 22 (18,3%) and lumbosacral segments - 67 (55,8%)the spine. Clinical-neurological, laboratory, functional-diagnostic (ENMG, evoked potentials),methods of radiation diagnosis (CT, MRI, Ultrasound) studies, and liquorodynamic tests aimed at study of circulation disorders and changes in the composition of cerebrospinal fluid(CSF).

Results: The clinical picture of SH with hydrocephalus is represented by an extensive clinical-neurological symptomatology, which includes deformation of the ventricular system (100%), motor (91,8%), pelvic (66,6%), sensitive disorders (82.5%) and orthopedic (60.0%) changes. By testing the structure of the hernial sac contents revealed the following: meningocele - y 10 (8.4%), meningoradiculocele - in 58 (48.3%) cases and myelocele - in 52 (43.3%) patients, and the tethering syndrome was present in 33 (27.5%) patients. CSF studies were conducted to determine the state of craniospinal system and refinement of cerebrospinal fluid. At the same time, the protein-cellular composition and dissociation of the CSF were defined. The study of liquorodynamics was reduced to for the adequate selection of parameters of shunting systems for patients with SH, combined with hydrocephalus. We applied the technique of fractional elimination of CSF from the ventricular system with constant monitoring of intracranial pressure. On its basis, determinated liquorodynamic test called "Breakpoints", as a sign of decompensation of the craniospinal compliance, which determines the critical deformation of the liquor system. A liquorodynamic test was used on the basis of computer the program "Liquorodynamic test" (DGU01982, 2010) in order to objectively defining the level of critical deformation of the ventricular system. The program works on the basis of an algorithm the excess of the arithmetic mean between the change rates cerebrospinal fluid pressure during the fractional elimination of cerebrospinal fluid. The program has a convenient interface and the ability to maintain an archive, as well as saving the database. In the cases with a progressive flow of hydrocephalus and the threat of rupture of the hernial sac to all patients were performed ventriculoperitoneostomy, as the first stage. In postoperative period in patients observed signs of adequate correction of hydrocephalic syndrome, as judged by the state of the hernial sac: its tension, the growth of the integumentary epithelium on the SCH and reduction in the neurological deficit. This facilitated the state of patients and allowed to subsequently produce herniectomy in a planned manner.

Conclusion: Thus, the use of a liquorodynamic test in preparation for a lumbar-shunting operation in children with SH with the reliability of more than 95.5% improves the dynamics of such indicators, as a hydrocephalic syndrome in 1.16, a decrease in the size of the skull - in 1.12 and hernial sac - 1.24 times (p≤0.05).