Targeting a zero blood transfusion rate in the repair of craniospinal dysraphism: outcome of a surgical technique for developing countries

Abstract

Objectives:

In Africa and other developing countries, the financial cost of the in-hospital acute surgical treatment of children with open neural tube defects (NTD) is often beyond the reach of the parents. Surgery-related blood transfusion requirements sometimes add to the concerns. Here, we present a surgical technique used in our practice to mitigate the blood transfusion issue.

Methods:

First, we present the technical report of our near-bloodless technique for targeting zero blood transfusion rate during the surgical repair of open cranial and spinal dysraphism. The technique is based on the generous use of the Bovie electrocautery in the initial phase of the surgical dissection. We also carried out an outcome analysis of its use in a prospective consecutive cohort of patients operated on over a 24-month period.

Results:

There were 48 NTDs in children aged 2–372 days. The widest diameter of the dysraphic lesions ranged from 3 to 14 cm (mean 5·8 ± 2·6); six were occipital encephalocoeles and the rest were spinal dysraphisms, 79·2% lumbosacral. The operative time ranged from 25 to 105 minutes (mean 59·6 ± 20·4); surgical blood loss was <10% of calculated total blood volume in 92% of the children, and none needed blood replacement. With only few minor wound issues recorded, healing of the surgical wound was by primary intention in 92%. There was no other unusual occurrence of postoperative neurological limb or sphincteric deficits.

Conclusion:

This surgical technique greatly reduces the need for operative blood replacement in the surgical repair of open craniospinal dysraphisms, and has acceptable rates of postoperative wound and neurological complications.

Keywords:

• Open NTDs
• Developing countries
• Bloodless surgical repair
• Technical outcome study

Acknowledgements

The author thanks Dr Ben Warf, Department of Neurosurgery, Children’s Hospital, Boston, MA, USA and an Associate Professor of Surgery, Harvard Medical School, for his help in improving the manuscript draft.