新生児期における脊髄脊髄膜瘤の治療及び管理

TREATMENT AND MANAGEMENT OF MYELOMENINGOCELE IN NEONATAL PERIOD

Ｉ．緒言

　開放性脊髄脊髄膜瘤は脊椎披裂の内で最も重症な型の奇型で脊髄自体が体表に露出している型のものである。従つて露出神経の乾燥，炎症を防ぐためには，新生児期の出来るだけ早期に緊急な手術的治療を必要とする。

　従来本邦では，この早期手術の重要性が十分に認識されていたとは言い難く，これは過去の文献に示されている如くである^1）2）。

We treated 15 cases of neonatal myelomeningo-celes in the last 4 years in the 2nd Surgical Department.

Most of the recent cases were closed early in the first 48 hours of life. Postoperative ventriculitis is one of the most difficult complications. We use intra-thecal injection of antibiotics and cortisone for this treatment.

We treat growing hydrocephalus with V-A shunting system after the complete cure of ventri-culitis. V-P shunt is not proper for the hydro-cephalus followed myelomeningocele, as most of the cases must be given intra-abdominal procedures for urinary abnormalities later.

Dribbling can be treated after the age of 2 with urinary diversion, but the difficulties of urination in neonatal cases is lethal, without treatment. Upper urinary system have been checked periodi-cally.

We use the i-t curve for orthopedic evaluation of motor function of lower limbs before closure of myelomeningocele. Various managements are necessary for giving the ability to walk from the neonatal period.

Myelomeningocele is the complicated disease condition and must be treated systimatically with a team-work of pediatric surgeon, neurosurgen, urologist and orthopedic surgeon.