Progressive Neurological Deficit in Children with Spina Bifida Aperta

Abstract

The results of re-operation of 15 patients with spina bifida aperta are reported. The operation was necessary because of neurological deterioration with increasing motor and bladder dysfunction. In all patients a tethered cord syndrome was present (CT-myelography). The myelum was adherent to the scar of the myelomeningocele repair. At operation the myelum is released from the adherent scar and in this way untethered. The early complications were mild except for one patient with decompensation of hydrocephalus. The aim of the operation was to stop further progression. The results of the operation were satisfactory with stabilisation of motor function in four patients and improvement of motor dysfunction in ten patients. Backache or fixation, bladder dysfunction and abnormal foot shape improved in some of the patients. In our experience the operative untethering procedure was useful. Intensive neurological control of operated spina bifida aperta patients is mandatory especially in those patients who can walk.

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

“…Another relevant issue is the use for each patient of the latest neurological level in medical evaluation, not considering the already known dynamic properties of neurological lesion level over time. 69,70 Moreover, clinical grading of muscle strength and assignment of neurosegmental level are subjective in nature, 71 and the reliability and validity of any classification system should be established. 72 Review of the literature is difficult because patients have been grouped according to different systems among the studies to classify the neurological level.…”

Lower Limb Movements and Urologic Function in Fetuses with Neural Tube and Other Central Nervous System Defects

“…Another factor could be the time needed for the damage to become function ally evident. SB is considered by many to be a progressive disorder with the neurological damage increasing with the growth of the fetus or infant [20,21]. If one could prove that there is progressive neurologic damage then this would give added impetus to con sider in utero repair of the spinal defect.…”

Adult Onset Subacute Sclerosing Panencephalitis: A case report

“…In stage II, continued intellectual deterioration and onset of typical pattern of myoclonic jerk, both are hallmarks of SSPE. Visual impairment and dressing apraxia may be apparent indicating parieto-occipital involvement 9 . In stage III, prominent hyperkinetic movements, choreoathetosis are noted indicating basal ganglia involvement.…”