the Effects of Platelet-Rich Plasma on Postoperative Complications After Meningomyelocele
Condition: Meningomyelocele/Spina Bifida
MeSH terms: Spinal Dysraphism; Meningomyelocele; Spina Bifida Cystica; Postoperative Complications
Study type: Interventional

Summary: 
      Introduction: Meningomyelocele is a common congenital neural tube defect. To reduce
      complications, early surgery and a multidisciplinary approach is needed. In this study, the
      investigators administered platelet-rich plasma (PRP) to newborns with meningomyelocele
      following corrective surgery to minimize cerebrospinal fluid (CSF) leakage and accelerate the
      healing of the immature pouch tissue. The investigators compared these with a control group
      that did not receive PRP.

      Patients and Methods: Of the 40 newborns who were operated on with the diagnosis of
      meningomyelocele, 20 patients received PRP after surgical repair, and 20 were followed up
      without PRP. In the PRP group, 10 of the 20 patients underwent primary defect repair, the
      other 10 underwent flap repair. In the group that did not receive PRP, primary closure was
      performed in 14 patients and flap closure in six.
    

Detailed description: 
      Introduction Meningomyelocele (MMC), a form of spina bifida, is the most common congenital
      anomaly of the central nervous system. It occurs in the first four weeks of pregnancy when
      the neural tube of the embryo fails to close. Neural tube defects may result in
      hydrocephalus, hindbrain herniation, and exposure to toxins in the amniotic fluid, with
      potential morbidity and mortality (1). Both environmental and genetic factors contribute to
      the etiology of MMC. The risk of MMC is increasing in the events of maternal exposure to
      valproate, alcohol, carbamazepine, or isotretinoin; high fever; malnutrition, especially
      folate or B12 deficiency, diabetes mellitus, or obesity during pregnancy (2). About 1,427
      babies are born with spina bifida each year in the United States (1 in 2,758 births). Lower
      socioeconomic status and older maternal age are associated with higher neural tube defect
      incidence. The recurrence rate in subsequent pregnancies is about 2% to 3% (3). More than 80%
      of babies born with MMC require a ventriculoperitoneal shunt for hydrocephalus decompression
      (4). In 39% of the patients, functional motor deficits are at the affected level or higher,
      and more than half of these have functional motor deficits two levels higher than the
      affected level (5). The purpose of early closure of MMC defects is to preserve neural tissue
      function and prevent sepsis.

      Platelet-rich plasma (PRP) is an autologous concentration of human platelets obtained from
      venous blood through proper centrifugation. It contains several growth factors including
      platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal
      growth factor (EGF), platelet-derived factor 4 (PF-4), insulin-like growth factor (IGF-1),
      and transforming growth factor-beta (TGF-b) (6). There are approximately 150-400 10³/mm³
      platelets in the blood and PRP contains between four and seven times this amount (7). When
      whole blood is collected from a patient for the generation of PRP, an anticoagulant is added.
      This usually contains citrate and disrupts the coagulation cascade by binding to calcium ions
      (8). PRP is used in orthopedic indications, wound healing, facial rejuvenation, hair
      restoration, and other conditions in which tissue renewal is central. The use of PRP for
      surgical and non-surgical wounds is advantageous, especially in patients with poor wound
      healing, poor blood supply, and slow cell turnover, and in cases where rapid healing is
      required.

      In this study, we assessed whether the administration of PRP during the MMC pouch repair
      procedure can improve infant outcomes. This was measured by its ability to reduce CSF
      leakage, meningitis, local infection, skin necrosis, wound dehiscence, and hydrocephalus, and
      to accelerate the healing of the underdeveloped pouch tissue. These outcomes were compared
      with those of an MMC control group who did not receive PRP during surgery.

      Materials and Methods This study included 40 infants with a diagnosis of MMC who were
      operated on at our neurosurgery clinic between February 2020 and May 2021. PRP was
      administered to 20 of the patients and 20 were followed up without PRP. All babies were born
      at term and fed with breast milk. All infants in the study were followed up in the neonatal
      intensive care unit. The mean birth weight was 2990 grams. In the PRP group, 10 of the 20
      patients underwent primary defect repair and 10 underwent flap repair. In the non-PRP group,
      14 patients underwent primary closure and six underwent flap closure. All operations were
      performed under general anesthesia. Blood was taken from each patient and the platelets were
      separated by centrifugation at 3200 rpm for five min in a 2 cc whole blood centrifuge device.
      The plasma was separated with the buffy coat layer. During MMC sac repair, a neural plate was
      formed and the dura was then made using opposing flaps from the fascia. After hemostasis was
      achieved, the defect was repaired and PRP was applied from the wound edge. The prepared PRP
      was applied to the dura and pouch repair and under the skin flap wound line.

      Descriptive statistics were expressed as means, standard deviations, medians, ranges,
      frequencies, and ratios. The distribution of variables was measured with the
      Kolmogorov-Smirnov test. Independent sample t-tests and Mann-Whitney U tests were used for
      the analysis of quantitative independent data. Chi-square tests were used in the analysis of
      qualitative independent data, and the Fischer test was used when the chi-square test
      conditions were not met. Analyses were performed using SPSS 27.0 software.
    

Intervention name(s): Use of Platelet-Rich Plasma after meningomyelocele sac repair; meningomyelocele sac repair
Intervention type(s): Procedure; Procedure
Intervention description(s): Wound healing with the use of Platelet-Rich Plasma after surgical meningomyelocele pouch repair; meningomyelocele sac repair without Platelet-Rich Plasma
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Meningomyelocele; myelomeningocele; neural tube defect; spina bifida; platelet-rich plasma; cerebrospinal fluid