Spinal dysraphism controversies: AIIMS experiences and contribution

Abstract

A large series of split cord malformation (SCM). Over the last 22 years, we have operated more than 1500 patients of SD, of which over 450 are (SCM), and 300 are with various lipomatus malformations. About 55% type II and 45% type I SCM. A separate sub-classification of type I SCM (a,b,c and d), is presented which alter the surgical approach and influence the results. Overall improvement following surgery in patients with SCM was observed in 94%. Fifty percent patients improved and 44% remained stable. However, deterioration was noticed in 6%, mostly with composite type of SCM. A paradigm for management of SCM is provided taking into consideration also the author’s large experience.

Prevalence of neural tube defects in a rural area of north india from 2001 to 2014: A population‐based survey

“…The distribution of spina bifida, anencephaly, and craniorachischisis matched with known relative frequencies of NTDs in established pregnancies (Copp et al, ). The most common site for spina bifida as observed in this study was lumbar, which was consistently seen in other studies as well (Hunter et al, ; Mahapatra ; Sargiotto et al, ). Consistent with the available literature, we found that the majority of the pregnancies with anencephaly culminated in stillbirth or death soon after birth.…”

Randomized clinical trial of acetazolamide administration and/or prone positioning in mitigating wound complications following untethering surgeries

“…25,30,32 The end point of closure in all untethering surgeries (with no respect to the underlying pathology) is the same and contains the watertight closure of dura and fascia. Despite the safety of the technique, complications such as CSF leakage, CSF collection, wound dehiscence, and infection are still reported, 19,23,27,30,31 and albeit rare, they might be serious, leading to meningitis or encephalitis. 21,31,34,40 Although various interventions are introduced as protective modalities for reducing the risk of these complications, 4,18 no evidenced-based or accepted guideline has yet been suggested.…”

“…6,22,23,41 It has also been suggested that early acetazolamide administration can prevent CSF leakage in high-risk patients. 1 In the case of intradural spine surgeries, acetazolamide is administered routinely as a prophylactic agent in some centers, 21,27 but its effectiveness has not yet been studied.…”

“…2,14,38 An untethering procedure may be associated with serious complications such as CSF leakage, CSF collection, wound dehiscence, and infection. 19,27,30,31 Despite a vast investigation of preventive interventions for such complications, 4,8,18,21,27 no evidenced-based guideline has yet been published.Although prophylactic administration of acetazolamide and/or bed rest following the intradural operation are acceptably used by both neurosurgeons and orthopedic surgeons, no high-level approved evidence exists regarding whether and how to use these measures.To the best of our knowledge, no randomized trial has assessed the prophylactic effect of acetazolamide in reducing complications following spinal surgeries. Likewise, abbreviations DS = dermal sinus; FF = fatty filum; LMMC = lipomyelomeningocele; SCM = slit cord malformation; TCS = tethered cord syndrome.…”

“…2,14,38 An untethering procedure may be associated with serious complications such as CSF leakage, CSF collection, wound dehiscence, and infection. 19,27,30,31 Despite a vast investigation of preventive interventions for such complications, 4,8,18,21,27 no evidenced-based guideline has yet been published.…”