Myelomeningocele — a single institute analysis of the years 2007 to 2015
After the introduction of folate supplementation, the number of open spinal dysraphism was successfully reduced over time. In 2007, the department for pediatric neurosurgery was established in the children’s hospital. Since then, newborns with myelomeningocele (MMC), the most common form of open neural tube defects (NTD), are treated here. The aim of this study is to present the concepts applied to and experiences resulting from treatment of MMC.
Records of all newborns with MMC treated surgically during the period January 2007 to August 2015 in our institution were analyzed. Children, who were previously operated in utero were excluded. The type of neural tube defect, its location, associated comorbidities, and ambulation were recorded.
Forty-eight children (25 males, 23 females) with spinal dysraphism were included in the analysis. In nearly 90 % of the cases, the repair of the MMC was done on the day of delivery. The follow-up period ranges from 9 weeks to 8 9/12 years (loss of follow-up in 2 cases). In 19 %, the defect remained undetected during gestation and in one case, carbamazepine was taken despite pregnancy. In 36 children (75 %), we found a Chiari malformation type II (CMII) associated with myelomeningocele. 85.4 % suffered from hydrocephalus and implantation of a shunt was necessary. In cases of bladder impairment, an intermittent catheterization was the most common management (83.3 %); no bladder augmentation was required. Twelve children required orthopedic surgery. Twenty-three of 33 patients (70 %) are ambulatory w/wo orthoses and devices. The 13 children who are younger than 2 years were considered separately to assess the motor activity safely.
Our data show that neural tube defects to this day can remain undetected despite medical care during pregnancy. The most common associated diseases with MMC are Chiari II malformations and hydrocephalus. In the seven cases of simultaneous repair of MMC with shunt implantation, no additional complications were encountered. An interdisciplinary approach was allowed in a high percentage independence and social continence.
KeywordsNeural tube defect Hydrocephalus Chiari malformation Spinal dysraphism
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest.
- 4.Goodrich JT (2007) A historical review of the surgical treatment of spina bifida. In: Özek MM, Cinalli G, Maixner WJ (eds) The spina bifida, Management and outcome. Springer, Chapter 1Google Scholar
- 5.Joyeux L, Engels AC, Russo FM, Jimenez J, Van Mieghem T, De Coppi P, Van Calenbergh F, Deprest J (2016) Fetoscopic versus open repair for spina bifida aperta: a systematic review of outcomes. Fetal Diagn Ther Feb 23. doi: 10.1159/000443498
- 7.Melo JRT, Pacheco P, de Melo EN, Vasconcellos A, Klein Passos R (2015) Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele. Arq Neuropsiquiatr: 759–763 doi: 10.1590/0004-282X20150110
- 11.Rütten T (1992) Demokrit lachender Philosoph & sanguinischer Melancholiker. Kap. 5, S. 106; Copyright 1992 by E.J. Brill Leiden, New York, Kopenhagen, KölnGoogle Scholar
- 14.Tulipan N, Wellons III JC, Thom EA, Gupta N, Sutton LN, Burrows PK, Farmer D, Walsh W, Johnson MP, Rand L, Tolivaisa S, D’Alton ME, Adzick NS (2015) Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr; Sept 15: doi: 10.3171/2015.7.PEDS15336
- 16.Wiebe B (2011) Checkliste “Erstversorgung von Neugeborenen mit Neuralrohrdefekten”. In: Ehlen M (ed) Klinikstandards Neonatologie, 1st edn. Georg Thieme Verlag KG, Stuttgart, pp. 175–176Google Scholar