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Child's Nervous System

, Volume 32, Issue 7, pp 1281–1287 | Cite as

Myelomeningocele — a single institute analysis of the years 2007 to 2015

  • Elke Januschek
  • Andreas Röhrig
  • Sandra Kunze
  • Christian Fremerey
  • Bea Wiebe
  • Martina Messing-Jünger
Original Paper

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Neural tube defect Hydrocephalus Chiari malformation Spinal dysraphism 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Elke Januschek
    • 1
    • 2
  • Andreas Röhrig
    • 2
  • Sandra Kunze
    • 2
  • Christian Fremerey
    • 3
  • Bea Wiebe
    • 3
  • Martina Messing-Jünger
    • 2
  1. 1.Neurosurgical DepartmentSana Klinikum Offenbach GmbHOffenbachGermany
  2. 2.Neurosurgical DepartmentAsklepios Children’s HospitalSankt AugustinGermany
  3. 3.Department of Neonatology and Pediatric Intensive Care MedicineAsklepios Children’s HospitalSankt AugustinGermany

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