Neurosurgical management of spina bifida: Research issues

Bowman, Robin; McLone, David G.

doi:10.1002/ddrr.100

Cited by 50 publications

(56 citation statements)

References 79 publications

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“…However, in our study we determined a shunt infection in only 1 patient, and we suggest that shunt insertion at the same time as the correction operation may be appropriate. There are a few studies reporting that early and aggressive surgery reduces complications and death prevalence in the short-term, and that it reduces urinary incontinence as well as duration of stay in the nursery in long-term follow-up [19,20,21,22,23]. In our study, no neonates died during the neonatal period.…”

Section: Discussionmentioning

confidence: 45%

Clinical Characteristics of Neonatal Meningomyelocele Cases and Effect of Operation Time on Mortality and Morbidity

Bülbül

Can²,

Bülbül³

et al. 2010

Pediatr Neurosurg

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Objective: We aimed to evaluate the clinical features, short-term prognosis, and effect of operation time on mortality and morbidity in neonates with meningomyelocele. Methods: This prospective study was conducted between January 2006 and December 2008. Clinical features, defective area, existence of additional anomalies, operation time, and morbidity and mortality data were recorded. The effectof operation time on mortality and morbidity was evaluated. Results: Patients (n = 28) were assessed during the study period. Mean birth weight, height, and head circumference were found to be 3,160 ± 582 g, 46.2 ± 3.3 cm, and 36.7 ± 4.1 cm, respectively. None of the mothers received folate supplementation. Hydrocephaly (n = 13), pes equinovarus (n = 4), pelvicalyceal ectasia (n = 4), acetabular dysplasia (n = 2), Chiari II malformation (n = 2), and hydronephrosis (n = 2) accounted for additional anomalies. The mean postnatal age for surgical operation was 3.2 ± 2.8 days; mean length of hospital stay was 10.2 ± 9.7 days. The cases operated after 72 h were hospitalized longer, received antibiotherapies for a longer duration and had higher total complication rates (p = 0.04, 0.02, and 0.01, respectively). Conclusion: Surgical operation of patients with meningomyelocele within 72 h after delivery significantly reduces not only the duration of hospitalization and antibiotic usage, but also complication rates.

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Section: Discussionmentioning

confidence: 45%

Clinical Characteristics of Neonatal Meningomyelocele Cases and Effect of Operation Time on Mortality and Morbidity

Bülbül

Can²,

Bülbül³

et al. 2010

Pediatr Neurosurg

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“…Optimally, back lesions should be closed within 72 hours of birth. A delay can have some impact on vital and functional prognoses, with higher risks of shunt malfunction and CNS infection [14][15][16][17] and worse neurogenic bladder prognosis. 18 In some patients, mostly from PALOP countries, there was a delay in MMC repair due to the unavailability of this procedure in their countries.…”

Section: Discussionmentioning

confidence: 99%

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

Marreiros

Loff

Calado

2014

The Journal of Spinal Cord Medicine

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Introduction: Children with myelomeningocele (MMC) are usually subjected to multiple surgeries. However, the number and type of surgeries are not the same in every patient with MMC over time. This report summarizes the surgical interventions in a cohort of several ages. Materials and methods: Data on all of the patients with MMC, aged from 1 year and 10 months to 21 years and 11 months, were retrospectively reviewed at the Dona Estefânia Hospital in Lisbon, Portugal. Data were collected by chart review and individual interviews. The factors analyzed were demographics, ambulatory status, neurological level of involvement, shunt status, Arnold-Chiari malformation type II, surgical history, and occurrence of fracture. The surgical interventions were categorized as neurosurgical, orthopedic, urinary, ulcer repair and others. Results: A total of 84 alive were eligible and enrolled. The average age was 14 years and six months. A total of 59 patients received shunts (all but one ventriculoperitoneal). In the study group, the 84 patients required 663 surgeries. Neurosurgical interventions were the most frequent surgical procedure and predominated during the first 2 years of life. Surgical interventions related to shunts were the most common neurosurgical interventions. Orthopedic surgeries were more frequent in the age group 6-12 years. Urological surgeries were done mainly after 6 years of age. Surgical repair of pressure ulcers was more common after 12 years of age. Conclusions: Our study brings to light the complexity of this condition, with multiple surgeries among patients with MMC.

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“…The neuroanatomical abnormalities usually include atypical development and caudal herniation of the cerebellum and hindbrain (the Chiari II malformation) (Tubbs et al, 2004), which occurs in 90% of individuals with SBM (Barkovich, 2005;Barkovich and Raybaud, 2012;Juranek and Salman, 2010). The aberrant configuration of the hindbrain resulting from the Chiari II malformation obstructs the flow of cerebrospinal fluid at the level of the fourth ventricle, leading to hydrocephalus in 80-90% of children with SBM, 50-80% of whom require the insertion of a shunt (Bowman and McLone, 2010;Reigel and Rotenstein, 1994).…”

Section: Introductionmentioning

confidence: 99%

Examination of Frontal and Parietal Tectocortical Attention Pathways in Spina Bifida Meningomyelocele Using Probabilistic Diffusion Tractography

et al. 2013

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Abnormalities of the midbrain tectum are common but variable malformations in spina bifida meningomyelocele (SBM) and have been linked to neuropsychological deficits in attention orienting. The degree to which variations in tectum structure influence white matter (WM) connectivity to cortical regions is unknown. To assess the relationship of tectal structure and connectivity to frontal and parietal cortical regions, probabilistic diffusion tractography was performed on 106 individuals (80 SBM, 26 typically developing [TD]) to isolate anterior versus posterior tectocortical WM pathways. Results showed that those with SBM exhibited significantly reduced tectal volume, along with decreased fractional anisotropy (FA) in posterior but not anterior tectocortical WM pathways when compared with TD individuals. The group with SBM also showed greater within-subject discrepancies between frontal and parietal WM integrity compared with the TD group. Of those with SBM, qualitative classification of tectal beaking based on radiological review was associated with increased axial diffusivity across both anterior and posterior tectocortical pathways, relative to individuals with SBM and a normal appearing tectum. These results support previous volumetric findings of greater impairment to posterior versus anterior brain regions in SBM, and quantifiably relate tectal volume, tectocortical WM integrity, and tectal malformations in this population.

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Neurosurgical management of spina bifida: Research issues

Cited by 50 publications

References 79 publications

Clinical Characteristics of Neonatal Meningomyelocele Cases and Effect of Operation Time on Mortality and Morbidity

Clinical Characteristics of Neonatal Meningomyelocele Cases and Effect of Operation Time on Mortality and Morbidity

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

Examination of Frontal and Parietal Tectocortical Attention Pathways in Spina Bifida Meningomyelocele Using Probabilistic Diffusion Tractography

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