Outcomes of Meningomyelocele Repair with or without Platelet Rich Plasma Application

Authors

  • Mahwish Noor ul Haq Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
  • Fatima Naumeri Department of Paediatric Surgery, Services Institute of Medical Sciences (SIMS), Lahore, Punjab, Pakistan.
  • Asad Munir Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
  • Hafiza Mariam Rafiq Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
  • Nadir Aman Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
  • Zuha Zafar Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i1.456

Keywords:

Meningomyelocele, Neural Tube Defects, Spina Bifida, Platelet Rich Plasma, Cerebrospinal Fluid

Abstract

Objective: Meningomyelocele (MMC) is a common congenital neural tube defect requiring early surgery and a multidisciplinary approach. This study aimed to minimize cerebrospinal (CSF) leakage and accelerate healing in infants undergoing corrective surgery. Methodology: The study consisted of 70 infants with meningomyelocele divided into two groups. The PRP group received platelet rich plasma during surgery, while the control group did not. Within the PRP group, 35 infants underwent primary defect repair. In the control group, 32 had primary repair and 3 had flap closure. Results:  The results demonstrated significant benefits of PRP treatment. In the PRP group, 5.7 %( 2 infants) experienced CSF leakage and 8.6% (3 infants) developed meningitis. Additionally, 17.1%(6 infants) had local skin infections and none had wound dehiscence. In contrast, the control group had substantially higher complications rates: 17.1%(6 infants) CSF leakage, 22.9%( 8 infants) meningitis, 45.7%(16) local skin infection and 12.9%(9 infants) wound dehiscence. Conclusion: This study concludes that PRP treatment significantly reduces CSF leakage, skin necrosis, meningitis and wound dehiscence in postoperative meningomyelocele infants. PRP enhances wound healing and minimizes complications, potentially reducing morbidity and mortality. These findings suggest PRP therapy as a valuable adjunct to meningomyelocele surgery.

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References

Moldenhauer, J. S., & Adzick, N. S. (2017). Fetal surgery for myelomeningocele: After the management of Myelomeningocele study (MOMS). Seminars in Fetal and Neonatal Medicine, 22(6), 360-366. https://doi.org/10.1016/j.siny.2017.08.004

Sahni, M., Alsaleem, M., & Ohri, A. (2019). Meningomyelocele. Stat Pearls Publishing, 13, 21-27.

Mai, C. T., Isenburg, J. L., Canfield, M. A., Meyer, R. E., Correa, A., Alverson, C. J., Lupo, P. J., Riehle‐Colarusso, T., Cho, S. J., Aggarwal, D., & Kirby, R. S. (2019). National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research, 111(18), 1420-1435. https://doi.org/10.1002/bdr2.1589

Rintoul, N. E., Sutton, L. N., Hubbard, A. M., Cohen, B., Melchionni, J., Pasquariello, P. S., & Adzick, N. S. (2002). A new look at Myelomeningoceles: Functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics, 109(3), 409-413. https://doi.org/10.1542/peds.109.3.409

Cochrane, D., Wilson, D., Steinbok, P., Farquharson, D. F., Irwin, B., Irvine, B., & Chambers, K. (1996). Prenatal spinal evaluation and functional outcome of patients born with Myelomeningocele: Information for improved prenatal counselling and outcome prediction. Fetal Diagnosis and Therapy, 11(3), 159-168. https://doi.org/10.1159/000264297

ARABACI, Ö., Akyol, M. E., Çelikkaleli, E., Sönmez, B., Çetin, E., & Beger, B. (2023). A randomized trial of the effects of plateletrich plasma on postoperative complications after meningomyelocele sac repair. European Review for Medical & Pharmacological Sciences, 27(12). https://www.europeanreview.org/wp/wp-content/uploads/5552-5558.pdf

Rehman, L., Sheikh, M., Afzal, A., & Rizvi, R. (2020). Risk factors, presentation and outcome of meningomyelocele repair. Pakistan Journal of Medical Sciences, 36(3). https://doi.org/10.12669/pjms.36.3.1237

Marques, L. F., Stessuk, T., Camargo, I. C., Sabeh Junior, N., Santos, L. D., & Ribeiro-Paes, J. T. (2014). Platelet-rich plasma (PRP): Methodological aspects and clinical applications. Platelets, 26(2), 101-113. https://doi.org/10.3109/09537104.2014.881991

Burnouf, T., Strunk, D., Koh, M. B., & Schallmoser, K. (2016). Human platelet lysate: Replacing fetal bovine serum as a gold standard for human cell propagation? Biomaterials, 76, 371-387. https://doi.org/10.1016/j.biomaterials.2015.10.065

Qian, Y., Han, Q., Chen, W., Song, J., Zhao, X., Ouyang, Y., Yuan, W., & Fan, C. (2017). Platelet-rich plasma derived growth factors contribute to stem cell differentiation in musculoskeletal regeneration. Frontiers in Chemistry, 5. https://doi.org/10.3389/fchem.2017.00089

Kakudo, N., Morimoto, N., Kushida, S., Ogawa, T., & Kusumoto, K. (2013). Platelet-rich plasma releasate promotes angiogenesis in vitro and in vivo. Medical Molecular Morphology, 47(2), 83-89. https://doi.org/10.1007/s00795-013-0045-9

Holmes, H. L., Wilson, B., Goerger, J. P., Silverberg, J. L., Cohen, I., Zipfel, W. R., & Fortier, L. A. (2018). Facilitated recruitment of mesenchymal stromal cells by bone marrow concentrate and platelet rich plasma. PLOS ONE, 13(3), e0194567. https://doi.org/10.1371/journal.pone.0194567

Jones, I. A., Togashi, R. C., & Thomas Vangsness, C. (2018). The economics and regulation of PRP in the evolving Field of orthopedic biologics. Current Reviews in Musculoskeletal Medicine, 11(4), 558-565. https://doi.org/10.1007/s12178-018-9514-z

Salarinia, R., Sadeghnia, H. R., Alamdari, D. H., Hoseini, S. J., Mafinezhad, A., & Hosseini, M. (2017). Platelet rich plasma: Effective treatment for repairing of spinal cord injury in rat. Acta Orthopaedica et Traumatologica Turcica, 51(3), 254-257. https://doi.org/10.1016/j.aott.2017.02.009

Qazi, G. (2010). Relationship of selected prenatal factors to pregnancy outcome and congenital anomalies. Journal of Ayub Medical College Abbottabad, 22(4), 41-45. https://ayubmed.edu.pk/JAMC/PAST/22-4/Gulrukh.pdf

Oncel, M. Y., Ozdemir, R., Kahilogulları, G., Yurttutan, S., Erdeve, O., & Dilmen, U. (2012). The effect of surgery time on prognosis in newborns with Meningomyelocele. Journal of Korean Neurosurgical Society, 51(6), 359. https://doi.org/10.3340/jkns.2012.51.6.359

Shaer, C. M., Chescheir, N., & Schulkin, J. (2007). Myelomeningocele: A review of the epidemiology, genetics, risk factors for conception, prenatal diagnosis, and prognosis for affected individuals. Obstetrical & Gynecological Survey, 62(7), 471-479. https://doi.org/10.1097/01.ogx.0000268628.82123.90

McLone, D. G. (1998). Care of the neonate with a Myelomeningocele. Neurosurgery Clinics of North America, 9(1), 111-120. https://doi.org/10.1016/s1042-3680(18)30284-5

Messing-Jünger, M., & Röhrig, A. (2013). Primary and secondary management of the Chiari II malformation in children with myelomeningocele. Child's Nervous System, 29(9), 1553-1562. https://doi.org/10.1007/s00381-013-2134-4

Mummareddy, N., Dewan, M. C., Mercier, M. R., Naftel, R. P., Wellons, J. C., & Bonfield, C. M. (2017). Scoliosis in myelomeningocele: Epidemiology, management, and functional outcome. Journal of Neurosurgery: Pediatrics, 20(1), 99-108. https://doi.org/10.3171/2017.2.peds16641

Everts, P., Onishi, K., Jayaram, P., Lana, J. F., & Mautner, K. (2020). Platelet-rich plasma: New performance understandings and therapeutic considerations in 2020. International Journal of Molecular Sciences, 21(20), 7794. https://doi.org/10.3390/ijms21207794

Coulange Zavarro, A., De Girolamo, L., Laver, L., Sánchez, M., Tischer, T., Filardo, G., Sabatier, F., & Magalon, J. (2022). The top 100 most cited articles on platelet-rich plasma use in regenerative medicine—A bibliometric analysis—From the ESSKA Orthobiologic initiative. Bioengineering, 9(10), 580. https://doi.org/10.3390/bioengineering9100580

M Marx, R. E. (2001). Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dentistry, 10(4), 225-228. https://doi.org/10.1097/00008505-200110000-00002

Wu, P. I-Kung., Diaz, R., & Borg-Stein, J. (2016). Platelet-Rich Plasma. Physical Medicine and Rehabilitation Clinics of North America, 27(4), 825–853. https://doi.org/10.1016/j.pmr.2016.06.002

Nguyen, R. T., Borg‐Stein, J., & McInnis, K. (2011). Applications of platelet‐rich plasma in musculoskeletal and sports medicine: An evidence‐based approach. PM&R, 3(3), 226-250. https://doi.org/10.1016/j.pmrj.2010.11.007

Demir, N., Peker, E., Gülşen, İ., Ağengin, K., & Tuncer, O. (2015). Factors affecting infection development after meningomyelocele repair in newborns and the efficacy of antibiotic prophylaxis. Child's Nervous System, 31(8), 1355-1359. https://doi.org/10.1007/s00381-015-2701-y

Lien, S. C., Maher, C. O., Garton, H. J., Kasten, S. J., Muraszko, K. M., & Buchman, S. R. (2010). Local and regional flap closure in myelomeningocele repair: A 15-year review. Child's Nervous System, 26(8), 1091-1095. https://doi.org/10.1007/s00381-010-1099-9

KHAN, A. (2018). Outcome of Myelomeningocele Repair and Early Post-operative Complications. Pakistan Journal of Neurological Surgery, 22(4), 200-205. https://pakjns.org/index.php/pjns/article/view/310

Tamburrini, G., Frassanito, P., Iakovaki, K., Pignotti, F., Rendeli, C., Murolo, D., & Di Rocco, C. (2013). Myelomeningocele: The management of the associated hydrocephalus. Child's Nervous System, 29(9), 1569-1579. https://doi.org/10.1007/s00381-013-2179-4

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Published

2025-01-08

How to Cite

Outcomes of Meningomyelocele Repair with or without Platelet Rich Plasma Application. (2025). Indus Journal of Bioscience Research, 3(1), 95-100. https://doi.org/10.70749/ijbr.v3i1.456