Spina Bifida Cystica: Results of Treatment of 270 Consecutive Cases with Criteria for Selection for the Future

Lorber, John

doi:10.1136/adc.47.256.854

Cited by 122 publications

(60 citation statements)

References 44 publications

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“…The instruments used to evaluate these children were (1) We obtained information on (1) size of family; (2) occupation of the breadwinner;…”

Section: Methodsmentioning

confidence: 99%

Intellectual and Perceptual-Motor Characteristics of Treated Myelomeningocele Children

Soare¹,

Raimondi²

1977

Arch Pediatr Adolesc Med

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\s=b\We studied 173 children with myelomeningocele, 133 of whom developed hydrocephalus (and had shunt procedures) and 40 of whom did not. Eighty siblings were tested as a control group. Sixty-three percent of children with hydrocephalus had IQs above 80; 87% of those without hydrocephalus had IQs above 80. Children who had associated hydrocephalus were significantly less intelligent than their siblings, whereas those without hydrocephalus were not. When patients and siblings were matched by age and IQ, the former scored significantly lower on a perceptual-motor functioning test. When patients with and without hydrocephalus were similarly matched, those with hydrocephalus scored lower. Inverse relationships between sac location and IQ, and sensory level and IQ, were found to be dependent on the association of higher sac levels and of sensory loss with hydrocephalus. Patient IQ was related to family income and education. (Am J Dis Child 131:199-204, 1977) With few exceptions,'-7 published reports of the intelligence of myelomeningocele children with (MM/H) and without (MM) hydro¬ cephalus have been limited to analyz¬ ing the natural history of nonoperatively treated hydrocephalus. By and large, these studies have been retro¬ spective, based on an accumulation of varying numbers of survivors. Simi¬ larly, the appraisals of survival, quali¬ ty of survival, and impact of the affected child on his home and enviFrom the Division of Neurological Surgery, IL 60614 (Dr Raimondi). ronment have been made from anal¬ yses of groups of children whose management has not been adequately described. METHODAs a first step in studying these children we established the criteria for diagnosing hydrocephalus in the child with myelomeningocele, determining precisely when a shunt was no longer functioning, compar¬ ing intellectual quotients with the presence or absence of hydrocephalus (treated, in the former event), using the siblings as the norm, and identifying (neuroradiologically) the nature and degree of brain dyspla¬ sia."'3 The two groups studied were myelomeningocele (MM) and shunted hy¬ drocéphalie myelomeningocele (MM/HS) children. The abbreviation MM/H refers to children who did not undergo a shunt procedure.There is, at the present time, consid¬ erable interest in the question of whether to treat such children at all, or whether treatment should be offered only to those children who may be expected to "live a meaningful life." Criteria on which such a decision may be based are lacking, though some arbitrary criteria (such as level of the myelomeningocele sac at birth, paraplegia, and hydrocephalus) have been suggested.In fact, one author has carried prediction to an extreme,' -reporting such a poor prog¬ nosis for myelomeningocele children with a thoracolumbar lesion, for example, irre¬ spective of the presence of hydrocephalus, that he recommends withholding all forms of treatment. This article presents the results of our study of the intellectual development of 173 children with myelomeningocele, 133 who had a shunt for...

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“…The instruments used to evaluate these children were (1) We obtained information on (1) size of family; (2) occupation of the breadwinner;…”

Section: Methodsmentioning

confidence: 99%

Intellectual and Perceptual-Motor Characteristics of Treated Myelomeningocele Children

Soare¹,

Raimondi²

1977

Arch Pediatr Adolesc Med

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“…Among those who would have died unoperated would have been the ones with the worst renal prognosis. As noted previously (3,6,9) the most severely afTeeted cases also had a worse renal prognosis. Where selection has been practised the overall mortality was higher (I, 2), the untreated cases generally dying in infancy, but the handicaps ofthe survivors were less severe (8,10,11).…”

Section: Discussionmentioning

confidence: 78%

A Study of Deaths and Handicap in a Consecutive Series of Spina Bifida Treated Unselectively from Birth

Gm¹

1983

Eur J Pediatr Surg

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In a consecutive series of spina bifida operated unselectively at birth 62% reached the twelfth birthday and 54% could be expected to reach the nineteenth. Many of the most severely affected cases survived; if they died the cause was usually renal failure. Bronchopneumonia was the main cause of death in infants and hydrocephalus in the older children. Girls outnumbered boys by 1:1.3 and, although they were more severely affected, their survival equalled the boys'. Awareness of the high survival rate which results from the treatment of spina bifida is important for the parents of a newborn baby. It is also a prerequisite in planning provision for the young adult.

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“…The ineidence of secondary upper urinary traet eomplieations in adoleseents with myelomeningocele is high but probably no greater than might ha\'e been antieipated from previous experience of their problems during childhood (4). Although the risk of developing eomplications inereases with the neurological deficit, it is still considerable even in those with only mild paralysis.…”

Section: Discussionmentioning

confidence: 96%

The Upper Renal Tracts in Adolescents and Young Adults with Myelomeningocele

Am¹,

Dg²

1984

Eur J Pediatr Surg

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The state of the upper urinary tracts has been assessed in 181 adolescents and young adults with myelomeningocele. At the age of 16 years, abnormalities were present in 75 patients (41 per cent); the risk of these complications was related to the extent of the neurological deficit and the presence of a urinary diversion. During follow-up into early adult life, fresh or further deterioration of the upper renal tracts occurred in 48 patients (27 per cent); the pattern of this deterioration was influenced by whether or not previous urinary diversion had been performed.

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Spina Bifida Cystica: Results of Treatment of 270 Consecutive Cases with Criteria for Selection for the Future

Cited by 122 publications

References 44 publications

Intellectual and Perceptual-Motor Characteristics of Treated Myelomeningocele Children

Intellectual and Perceptual-Motor Characteristics of Treated Myelomeningocele Children

A Study of Deaths and Handicap in a Consecutive Series of Spina Bifida Treated Unselectively from Birth

The Upper Renal Tracts in Adolescents and Young Adults with Myelomeningocele

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