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Myelomeningocele Primary Repair Surgical Technique

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The Spina Bifida

Abstract

A clear understanding of the pathologic anatomy of the spinal malformation is a fundamental prerequisite of the pre-operative work-up in spina bifida patients [1]. The malformed spinal cord or primitive neural plaque (placode) presents as a flat tongue of neural tissue with its borders merging into the contiguous malformed meningeal coverings. As an effect of the failed neurulation process, both ventral and dorsal spinal roots exit from the ventral aspect of the placode, the dorsal roots exiting laterally to the ventral ones, and corresponding to the boundary between the placode and the arachnoid membrane (junctional zone). The presence of an intact subarachnoid space ventral to the placode confirms the lesion as a myelomeningocele (MMC) (Fig. 10.1), whereas its absence confirms it to be a myelocele, which more closely resembles the deranged anatomy of failed neurulation (Fig. 10.2).

Clinical appearance of a lumbar myelomeningocele (a) and schematic drawing (b)of the malformation, demonstrating the relationship of the placode with the subarachnoid space and cutaneous layers, and the exit and course of the spinal roots within the malformed sac

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References

  1. Amacher L (1978) The microsurgical anatomy of lumbar rachischisis. Adv Ophthalmol 37. Karger, Basel, pp 197–202

    Google Scholar 

  2. Dias MS (1999) Myelomeningocele. In: Choux M, Di Rocco C, Hockley AD, Walker ML (eds) Pediatric neurosurgery. Churchill Livingstone, London, pp 33–59

    Google Scholar 

  3. Reigel DH, Dallmann DE, Scarff TB, Woodford J (1976) Intra-operative evoked potential studies of newborn infants with myelomeningocele. Dev Med Child Neurol 37(suppl):42–49

    Google Scholar 

  4. McGlaughlin TP, Banta JV, Gahm NH, Raycroft JF (1986) Intraspinal rhizotomy and distal cordectomy in patients with myelomeningocele. J Bone Joint Surg 68A:88–94

    Google Scholar 

  5. McLone DG (1998) Care of the neonate with a myelomeningocele. Neurosurg Clin North Am 9:111–120

    CAS  Google Scholar 

  6. McLone DG (2005) Spinal dysraphism: impact of technique and technology on expectations. Clin Neurosurg 52:261–264

    PubMed  Google Scholar 

  7. Park T (1999) Myelomeningocele. In: Albright L, Pollack I, Adelson D (eds) Principles and practice of pediatric neurosurgery. Thieme, New York, pp 291–320

    Google Scholar 

  8. Cohen AR, Robinson S (2001) Early management of myelomeningocele. In: McLone DG (ed) Pediatric neurosurgery. Saunders, Philadelphia, pp 241–258

    Google Scholar 

  9. Charney E, Walker S, Sutton L et al (1985) Management of the newborn with myelomeningocele. Time for a decision-making process. Pediatrics 75:58–64

    PubMed  CAS  Google Scholar 

  10. McLone DG (1983) Results of treatment of children born with a myelomeningocele. Clin Neurosurg 30:407–412

    PubMed  CAS  Google Scholar 

  11. Shurtleff D, Lemire R (1995) Epidemiology, etiologic factors, and prenatal diagnosis of open spinal dysraphism. Neurosurg Clin North Am 6:183–193

    CAS  Google Scholar 

  12. Tarcan T, Onol FF, Ilker Y et al (2006) The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelo — meningocele. J Urol 176(3):1161–1165

    Article  PubMed  Google Scholar 

  13. Luthy DA, Wardinsky T, Shurtleff DB (1991) Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed antenatally. N Engl J Med 324:662–666

    PubMed  CAS  Google Scholar 

  14. Cochrane D, Aronyk K, Sawatzky B et al (1991) The effects of labor and delivery on spinal cord function and ambulation in patients with meningomyelocele. Childs Nerv Syst 7:312–315

    Article  PubMed  CAS  Google Scholar 

  15. Merrill DC, Goodwin P, Burson JM et al (1998) The optimal route of delivery for fetal meningomyelocele. Am J Obstet Gynecol 179:235–240

    Article  PubMed  CAS  Google Scholar 

  16. Masini L, De Santis M, Noia G et al (2002) Spina bifida: prenatal diagnosis ultrasonographic diagnosis and long-term follow-up in 127 cases. Ultrasound Obstet Gynecol 20(suppl):17

    Google Scholar 

  17. Di Rocco C, Caldarelli M, Ceddia A, Rende M (1989) Hydrocephalus and Chiari malformation. In: Gjerris F, Borgesen SE, Sorensen PS (eds) Outflow of cerebrospinal fluid. Munksgaard, Copenhagen, pp 106–118

    Google Scholar 

  18. Dias MS, McLone DG (1993) Hydrocephalus in the child with dysraphism. Neurosurg Clin N Am 4:715–726

    PubMed  CAS  Google Scholar 

  19. Albright AL, Haines SJ, Taylor FH (1988) Function of parietal and frontal shunts in childhood hydrocephalus. J Neurosurg 69:883–886

    PubMed  CAS  Google Scholar 

  20. Bierbrauer KS, Storrs BB, McLone DG et al (1990–91) A prospective, randomized study of shunt function and infections as a function of shunt placement. Pediatr Neurosurg 16:287–291

    Article  PubMed  Google Scholar 

  21. Sainte-Rose C, Piatt JH, Renier D et al (1991–92) Mechanical complications in shunts. Pediatr Neurosurg 17:2–9

    Article  PubMed  Google Scholar 

  22. Chadduck W, Reding D (1988) Experience with simultaneous ventriculoperitoneal shunt placement and myelomeningocele repair. J Pediatr Surg 23:913–916

    Article  PubMed  CAS  Google Scholar 

  23. Parent AD, McMillan T (1995) Contemporaneous shunting with repair of myelomeningocele. Pediatr Neurosurg 22:132–135

    Article  PubMed  CAS  Google Scholar 

  24. Miller PD, Pollack IF, Pang D, Albright AL (1996) Comparison of simultaneous versus delayed ventriculoperitoneal shunt insertion in children undergoing myelomeningocele repair. J Child Neurol 11:370–372

    PubMed  CAS  Google Scholar 

  25. Gamache F (1995) Treatment of hydrocephalus in patients with meningomyelocele or encephalocele. A recent series. Childs Nerv Syst 11:487–488

    Article  PubMed  Google Scholar 

  26. Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748–754

    PubMed  CAS  Google Scholar 

  27. Teo C, Jones R (1996) Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 25:57–63

    Article  PubMed  CAS  Google Scholar 

  28. Fritsch MJ, Mehdorn HM (2003) Indication and controversies for endoscopic third ventriculostomy in children. Childs Nerv Syst 19:706–707

    Google Scholar 

  29. Walker DG, Coyne TJ, Kahler RJ, Tomlinson FH (2003) Failure of endoscopic third ventriculostomy in myelomeningocele patients: preoperative clinical and radiological features. Childs Nerv Syst 19:707–708

    Google Scholar 

  30. Tamburrini G, Caldarelli M, Massimi L et al (2004) Primary and secondary endoscopic third ventriculostomy in children with hydrocephalus and myelo — meningocele. Childs Nerv Syst 20:666

    Google Scholar 

  31. Reigel DH, McLone DG (1987) Myelomeningocele: Operative treatment and results. Karger, Basel

    Google Scholar 

  32. McLone DG (1990) Technique for closure of myelomeningocele. Childs Nerv Syst 6:66–73

    Article  Google Scholar 

  33. Rendeli C, Nucera E, Ausili E et al (2006) Latex sensitisation and allergy in children with myelomeningocele. Childs Nerv Syst 22:28–32

    Article  PubMed  CAS  Google Scholar 

  34. Conran AM, Kahana M (1998) Anesthetic considerations in neonatal neurosurgical patients. Neurosurg Clin N Am 9:181–185

    PubMed  CAS  Google Scholar 

  35. Haddad FS (1997) Draping an infant for repair of meningomyelocele. Surg Neurol 48:530

    Article  PubMed  CAS  Google Scholar 

  36. Reigel DH (1979) Kyphectomy and myelomeningocele repair. Modern techniques in surgery. Neurosurgery 13:1–9

    Google Scholar 

  37. Iskander BJ, McLaughlin C, Oakes WJ (2000) Split cord malformations in myelomeningocele patients. Br J Neurosurg 14:200–203

    Article  Google Scholar 

  38. Kumar R, Bansal KK, Chhabra DK(2002) Occurrence of split cord malformation in meningomyelocele: complex spina bifida. Pediatr Neurosurg 36:119–127

    Article  PubMed  Google Scholar 

  39. Venes JL (1985) Surgical considerations in the initial repair of meningomyelocele and the introduction of a technical modification. Neurosurgery 17:111–113

    Article  PubMed  CAS  Google Scholar 

  40. McCullough DC, Johnson DL (1994) Myelomeningocele repair: technical considerations and complications. 1988. Pediatr Neurosurg 21:83–90

    Article  PubMed  CAS  Google Scholar 

  41. McLone DG, Dias MS (1991–92) Complications of myelomeningocele closure. Pediatr Neurosurg 17:267–273

    Article  PubMed  Google Scholar 

  42. Pang D (1995) Surgical complications of open spinal dysraphism. Neurosurg Clin North Am 6:243–257

    CAS  Google Scholar 

  43. Caldarelli M, Di Rocco C, Colosimo C Jr et al (1995) Surgical treatment of late neurological deterioration in children with myelodysplasia. Acta Neurochir (Wien) 137:199–206

    Article  CAS  Google Scholar 

  44. Scott RM, Wolpert SM, Bartoshesky LE et al (1986) Dermoid tumors occurring at the site of previous myelomeningocele repair. J Neurosurg 65:779–783

    PubMed  CAS  Google Scholar 

  45. Park TS, Delashaw JB, Broaddus WC, Vollmer DG (1985–86) Lyophilized cadaver dura mater for primary repair of myelomeningoceles. Pediatr Neurosci 12:315–319

    Article  PubMed  Google Scholar 

  46. Laquerriere A, Yun J, Tiollier J et al (1993) Experimental evaluation of bilayered human collagen as a dural substitute. J Neurosurg 78:487–491

    Article  PubMed  CAS  Google Scholar 

  47. Knopp U, Christmann F, Reusche E, Sepehrnia A (2005) A new collagen biomatrix of equine origin versus a cadaveric dura graft for the repair of dural defects — a comparative animal experimental study. Acta Neurochir (Wien) 147:877–887

    Article  CAS  Google Scholar 

  48. Pettorini B, Tamburrini G, Massimi L et al (2006) The use of a collagen foil dura mater substitute in pediatric neurosurgical procedures. Childs Nerv Syst 22:1044–1045

    Google Scholar 

  49. Babuccu O, Kalayci M, Peksoy I et al (2004) Effect of cerebrospinal fluid leakage on wound healing in flap surgery: histological evaluation. Pediatr Neurosurg 40:101–106

    Article  PubMed  Google Scholar 

  50. Fiala TG, Buchman SR, Muraszko KM (1996) Use of lumbar periosteal turnover flaps in myelomeningocele closure. Neurosurgery 39:522–525

    Article  PubMed  CAS  Google Scholar 

  51. Lanigan MW (1993) Surgical repair of myelomeningocele. Ann Plast Surg 31:514–521

    Article  PubMed  CAS  Google Scholar 

  52. Lehrman A, Owen MP (1984) Surgical repair of large meningomyeloceles. Ann Plast Surg 12:501–507

    Article  PubMed  CAS  Google Scholar 

  53. Perry VL, Albright AL, Adelson PD (2002) Operative nuances of myelomeningocele closure. Neurosurgery 51:719–723

    Article  PubMed  Google Scholar 

  54. Lehman RA, Page RB, Saggers GC, Manders EK (1985) Technical note: the use of nitroglycerin ointment after precarious neurosurgical wound closure. Neurosurgery 16:701–702

    Article  PubMed  CAS  Google Scholar 

  55. Ozveren MF, Erol FS, Topsakal C et al (2002) The significance of the percentage of the defect size in spina bifida cystica in determination of the surgical technique. Childs Nerv Syst 18:614–620

    Article  PubMed  CAS  Google Scholar 

  56. de Chalain TM, Cohen SR, Burstein FD et al (1995) Decision making in primary surgical repair of myelomeningocele. Ann Plast Surg 35:272–278

    Article  PubMed  Google Scholar 

  57. Mowatt DJ, Thomson DN, Dunaway DJ (2005) Tissue expansion for the delayed closure of large myelomeningoceles. J Neurosurg 103(suppl 6):544–548

    PubMed  Google Scholar 

  58. Arnell K (2006) Primary and secondary tissue expansion gives high quality skin and subcutaneous coverage in children with a large myelomeningocele and kyphosis. Acta Neurochir (Wien) 148:293–297

    Article  CAS  Google Scholar 

  59. Ersahin Y, Yurtseven T (2004) Delayed repair of large myelomeningoceles. Childs Nerv Syst 20:427–429

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery and Centre for Spina Bifida, Catholic University Medical School, Rome, Italy

    Massimo Caldarelli & Concezio Di Rocco

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  1. Massimo Caldarelli
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  2. Concezio Di Rocco
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Caldarelli, M., Rocco, C.D. (2008). Myelomeningocele Primary Repair Surgical Technique. In: The Spina Bifida. Springer, Milano. https://doi.org/10.1007/978-88-470-0651-5_10

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  • DOI: https://doi.org/10.1007/978-88-470-0651-5_10

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0650-8

  • Online ISBN: 978-88-470-0651-5

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