Surgical treatment of late neurological deterioration in children with myelodysplasia
- 51 Downloads
Late deterioration of the neurological condition in patients operated on for myelomeningocele repair has been repeatedly reported in the literature. At the present time magnetic resonance imaging (MRI) allows one to recognize various pathological conditions which can be amenable to surgical correction in these patients, such as Chiari type II malformation, hydro/syringomyelia, decompensated hydrocephalus, and tethered spinal cord.
The authors report their experience with 26 myelodysplastic children operated on for myelomeningocele repair in the early neonatal period, who exhibited late deterioration at variable time intervals from the first operation. The children were examined pre-operatively by means of MRI; the results were compared with those provided by MRI in 46 myelodysplastic children who underwent the investigation as a routine follow-up control. The MRI findings were subdivided into 4 main groups of increasing severity from 1 to 4; in some subjects, associated pathological conditions (Chiari II malformation, hydromyelia, etc.) were detected as well.
Twenty-two out of the 26 patients with late neurological deterioration were operated on. Eleven of them (grades 2 to 4) underwent detethering of the fixed conus, with an improvement of their clinical picture from mild to good. On the other hand the remaining 11 subjects (grades 1 to 2) improved their condition following the correction of the associated abnormalities (malfunctioning CSF shunt: 5 cases; hydromyelia: 4 cases; symptomatic Chiari II malformation: 2 cases).
KeywordsTethered spinal cord spinal dysraphism magnetic resonance imaging post-repair myelomeningocele
Unable to display preview. Download preview PDF.
- 3.Barnes PD, Lester PD, Yamanashi WS, Prince JR (1986) Magnetic resonance imaging in infants and children with spinal dysraphism. AJNR 7: 465–472Google Scholar
- 6.Caldarelli M, Ceddia A, Di Rocco C, Iannelli A, Velardi F (1989) La sindrome del Tethered Cord nei bambini operati per mielomeningocele. Atti XXXVIII Congresso della Società Italiana di Neurochirurgia, Minerva Medica, Torino, pp 719–723Google Scholar
- 9.Fitz CR, Harwood-Nash DC (1975) The tethered conus. AJR 125: 515–523Google Scholar
- 10.Gryspeerdt GL (1963) Myelographic assessment of occult forms of spinal dysraphism. Acta Radiol 1: 702–717Google Scholar
- 12.Hall WA, Albright AL, Brunberg JA (1988) Diagnosis of tethered cords by magnetic resonance imaging. Surg Neurol 30: 40–60Google Scholar
- 18.McLone DG, Naidich TP (1989) Myelomeningocele: outcome and late complication. In: McLaurin RL, Schut L, Venes JL, Epstein F (eds) Pediatrie neurosurgery. Saunders, Philadelphia, pp 53–70Google Scholar
- 19.McLone DG, Naidich TP (1989) The tethered spinal cord. In: McLaurin RL, Schut L, Venes JL, Epstein F (eds) Pediatric neurosurgery. Saunders, Philadelphia, pp 71–96Google Scholar
- 24.Reigel DH (1983) Tethered spinal cord. In: Humphreys RP (ed) Concepts in pediatric neurosurgery, Vol 4. Karger, Basel, pp 142–164Google Scholar
- 27.Tamaki N, Shirataki K, Kojima N, Shouse Y, Matsumoto S (1988) Tethered cord syndrome of delayed onset following repair of myelomeningocele. J Neurosurg 69: 116–123Google Scholar
- 29.Venes JL, Stevens EA (1983) Surgical pathology in tethered cord secondary to myelomeningocele repair. Implications for initial closure technique. In: Humphreys RP (ed) Concepts in pediatric neurosurgery, Vol 4. Karger, Basel, pp 165–185Google Scholar