Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients

Talamonti, Giuseppe; D’Aliberti, Giuseppe; Collice, Massimo

doi:10.3171/ped-07/11/368

Cited by 69 publications

(82 citation statements)

References 56 publications

(138 reference statements)

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“…Patient age at retethering is approximately between 5 and 9 years, usually during stages of rapid growth. 32,40 Phuong et al 32 retrospectively reviewed 45 cases of repaired MMC with TCS that did not undergo a detethering procedure and found that 60% of the patients progressed with TCS and 89% needed other surgical procedures, including contracture release and bladder augmentation. Class 1 or 2 evidence does not yet exist for timing of detethering, but George and Fagan 9 performed an evidence-based literature review and reported that tethered cord release should be considered when symptoms, imaging studies, urodynamics, and somatosensory evoked potentials are consistent with TCS.…”

Section: Myelomeningocelementioning

confidence: 99%

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Hertzler¹,

DePowell²,

Stevenson³

et al. 2010

FOC

221

142

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Tethered cord syndrome (TCS) is a clinical condition of various origins that arises from tension on the spinal cord. Radiographic findings may include the conus medullaris in a lower than normal position, fatty infiltration of the filum terminale, lipomyelomeningocele, myelomeningocele, myelocystocele, meningocele, split cord malformations, dermal sinus, anorectal malformations, and intraspinal tumors. The clinical constellation of signs and symptoms associated with TCS may include dermatologic, urological, gastrointestinal, neurological, and orthopedic findings. The current review focuses on TCS by age group of the more common causes of the condition, including myelomeningocele, lipomyelomeningocele, as well as the adult presentation of occult TCS. Pertinent review of the neuroembryology and normal anatomical position of the conus medullaris is included.

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Section: Myelomeningocelementioning

confidence: 99%

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Hertzler¹,

DePowell²,

Stevenson³

et al. 2010

FOC

221

142

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show abstract

“…19) However, it is thought that spinal MR imaging is not always essential, because surgical repair is considered to be a priority and must be performed as soon as possible. 52) Furthermore, with the recent advances in prenatal high-resolution MR imaging, no additional information can be obtained by postnatal MR imaging. 1) However, in our institution, we perform both spinal and cranial MR imaging.…”

Section: Perinatal Managementmentioning

confidence: 99%

“…In such cases, underlying muscle closure is important to obtain good wound healing. 52) There are many reports of plastic surgical closures. 26,27,41,50)…”

Section: Repair Surgery For Myeloschisismentioning

confidence: 99%

“…The goals of separation of the placode are to reduce the possibility of future tethering and to enable subsequent reconstruction of a normal neural tube. 52) Thus, the caudal end of the placode or terminal filum, if identified, can be sectioned based on the results of electrical stimulation. 12,52) Once the placode has been separated from the intermediate zone, it should be carefully inspected so as to remove any potential tissue that could form a dermoid at a later date (Fig.…”

Section: Repair Surgery For Myeloschisismentioning

confidence: 99%

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Neurosurgical Management of Patients With Lumbosacral Myeloschisis

Morioka

Hashiguchi

Mukae

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Myeloschisis is the most serious and complex congenital anomaly in spina bifida manifesta (cystica). However, with improvements in medical care and increased understanding of its pathophysiology, the associated long-term morbidity and mortality rates have been significantly reduced. This article reviews various issues associated with the neurosurgical management of patients with myeloschisis, such as perinatal management, repair surgery for myeloschisis, neurosurgical management of hydrocephalus, Chiari malformation type II, tethered cord syndrome and epilepsy, and intrauterine fetal surgery.

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“…9,16 In addition, virtually all patients with MM radiographically demonstrate a tethered spinal cord, 6,13 although only 10-30% exhibit symptoms. 1,2,15 This occurs due to a difficulty in closing the dura mater around the neural placode to keep it bathed in CSF and prevent adherence to the dura.…”

mentioning

confidence: 99%

A patient with myelomeningocele: is untethering necessary prior to scoliosis correction?

Samdani¹,

Fine²,

Sagoo³

et al. 2010

FOC

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Object Tethering of the spinal cord is thought to increase the chance of neurological injury when scoliosis correction is undertaken. All patients with myelomeningocele (MM) are radiographically tethered, and untethering procedures carry significant morbidity risks including worsening neurological function and wound complications. No guidelines exist as regards untethering in patients with MM prior to scoliosis correction surgery. The authors' aim in this study was to evaluate their experience in patients with MM who were not untethered before scoliosis correction. Methods Seventeen patients with MM were retrospectively identified and 1) had no evidence of a clinically symptomatic tethered cord, 2) had undergone spinal fusion for scoliosis correction, and 3) had not been untethered for at least 1 year prior to surgery. The minimum follow-up after fusion was 2 years. Charts and radiographs were reviewed for neurological or shunt complications in the perioperative period. Results The average age of the patients was 12.4 years, and the following neurological levels were affected: T-12 and above, 7 patients; L-1/L-2, 6 patients; L-3, 2 patients; and L-4, 2 patients. All were radiographically tethered as confirmed on MR imaging. Fourteen of the patients (82%) had a ventriculoperitoneal shunt. The mean Cobb angle was corrected from 82° to 35°, for a 57% correction. All patients underwent neuromonitoring of their upper extremities, and some underwent lower extremity monitoring as well. Postoperatively, no patient experienced a new cranial nerve palsy, shunt malfunction, change in urological function, or upper extremity weakness/sensory loss. One patient had transient lower extremity weakness, which returned to baseline within 1 month of surgery. Conclusions The study results suggested that spinal cord untethering may be unnecessary in patients with MM who are undergoing scoliosis corrective surgery and do not present with clinical symptoms of a tethered cord, even though tethering is radiographically demonstrated.

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Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients

Cited by 69 publications

References 56 publications

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Tethered cord syndrome: a review of the literature from embryology to adult presentation

Neurosurgical Management of Patients With Lumbosacral Myeloschisis

A patient with myelomeningocele: is untethering necessary prior to scoliosis correction?

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