Myelomeningocele Repair: Technical Considerations and Complications

McCullough, David C.; Johnson, Dennis L.

doi:10.1159/000120820

Cited by 21 publications

(14 citation statements)

References 17 publications

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“…No dermal elements were detected in the cyst in our case, indicating it was not a dermal inclusion cyst. Cases of CSF fistula have been preshunt status and have rapidly responded to treatment of the hydrocephalus [2], but in our case, the CSF fistula failed to respond to shunt revision. Once a delayed CSF fistula occurs at the site of an old wound, it is difficult for the fistula to be closed by granulation.…”

Section: Discussionmentioning

confidence: 56%

“…CSF leaks were rarely associated with infection. McCulluough and Johnson reported that CSF fistulas occurred in 2 of 100 myelomeningocele patients and that it rapidly responded to treatment of their hydrocephalus [2]. However, to our knowledge delayed CSF leakage at the operated site is quite rare.…”

Section: Discussionmentioning

confidence: 73%

“…The major complications of myelomeningocele repair are wound infection, dehiscence, and cerebrospinal fluid (CSF) fistula [1,2]. In a recent review of primary closure of myelomeningoceles, the occurrence of CSF leaks was rarely associated with infection.…”

Section: Introductionmentioning

confidence: 99%

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Delayed CSF Pseudocyst following Shunt Malfunction after Myelomeningocele Repair.

et al. 2000

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Summary:We report a case of delayed cerebrospinal fluid (CSF) pseudocyst following shunt malfunction in a 20-year-old patient with myelomeningocele. Magnetic resonance (MR) images and a radioimmunoassay shunt-gram detected the CSF fistula at the old scar of the myelomeningocele repaired 20 years before. Since the revision of the shunt system failed to keep the pseudocyst, the lesion was successfully directly repaired. Treatment of the delayed CSF pseudocyst following shunt malfunction thus requires a radical operation of the lesion.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 73%

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Delayed CSF Pseudocyst following Shunt Malfunction after Myelomeningocele Repair.

et al. 2000

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“…A teoria hidrodinâmica de Gardner [16][17][18] propõe que a imperfuração da fossa rombóide leve à distensão excessiva do tubo neural e consequente deslocamento caudal das estruturas da fossa posterior. Cameron 3 sugere que a herniação ocorra em 20 , o número dos que necessitam especial atenção para este problema não excederia 6%. A MChII pode se manifestar em qualquer idade, e é mais severa em recém-nascidos e lactentes com menos de um ano de vida 21,22 , sendo melhor a resposta ao tratamento em crianças maiores e adolescentes 9,22,23 .…”

Section: Discussionunclassified

Malformação de Chiari do tipo II sintomática

Salomão

Bellas

Leibinger

et al. 1998

Arq. Neuro-Psiquiatr.

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RESUMO -Os autores analisam uma série de 17 crianças portadoras de mielodisplasias que desenvolveram sinais e sintomas da malformação de Chiari do tipo II. De acordo com a idade, dois grupos ficaram bem definidos: Grupo I, crianças no primeiro ano de vida, em que predominaram sinais e sintomas de comprometimento do tronco encefálico e nervos cranianos bulbares (n=13); Grupo II, composto por crianças com idade superior a um ano, em que as principais manifestações foram dor cervical e sinais cerebelares (n=4). O resultado do tratamento cirúrgico nos dois grupos foi distinto: enquanto a mortalidade no Grupo I atingiu 46,1%, nenhum paciente do Grupo II veio a falecer. O tratamento inicial consistiu na instalação ou revisão de derivação ventricular, sendo a descompressão crânio-vertebral reservada àqueles que não se beneficiaram com esses procedimentos. Os autores enfatizam a necessidade do imediato reconhecimento e tratamento do quadro, de modo a se obter resultados satisfatórios.PALAVRAS-CHAVE: mielomeningocele, malformação de Chiari do tipo II, malformação de ArnoldChiari, desconpressão de fossa craniana posterior, hidrocefalia, paralisia de cordas vocais. Symptomatic Chiari type II malformationABSTRACT -The Chiari type II malformation is the leading cause of death in infants with myelomeningocele. The authors report 17 cases of symptomatic Chiari type II malformation occurring in two distinct age dependent population. In Group I, 13 neonates and infants in the first year of life presented with cranial nerve and brain stem dysfunction characterized by vocal cord paralysis, apnea, dysphagia and laryngeal stridor. In Group II, 4 patients developed signs and symptoms after the first year of life. In this group, the presentation was more insidious and included neck pain and cerebellar manifestations. The surgical treatment consisted initially in shunt implantation or revision and when there was no improvement, posterior fossa decompression was performed. The response to the surgical treatment differed considerably between the two groups: older patients improved promptly after surgery and there was no casualties; in newborn and infants, especially those under 6 months of age, the mortality rate was 46.1%. The authors stress that prompt diagnosis and surgical intervention should be performed in order to produce a favorable outcome.

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“…Myelomeningocele is one of the most common congenital defects of the central nervous system [1]. It is a neural tube defect with spinal bonny malformation leading to an incomplete spinal canal.…”

Section: Introductionmentioning

confidence: 99%

Fetus Support Manipulator with Flexible Balloon-Based Stabilizer for Endoscopic Intrauterine Surgery

Liao

Suzuki

Matsumiya

et al. 2006

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2006

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Abstract. A novel manipulator is described for stabilizing fetus and preventing it from free-floating during the endoscopic intrauterine surgery. Minimally invasive endoscopic fetal surgery enables intrauterine intervention with reduced risk to the mother and fetus. We designed and fabricated a prototype of a fetus supporting manipulator equipped with a flexible bending/curving mechanisms and a soft balloon-based stabilizer. The flexible bending and curving mechanisms enable the stabilizer to reach the target sites within the uterus under an ultrasound-guidance. The balloon-based stabilizer could be inserted into the uterus with a small incision for entry. The accuracy evaluation showed that the maximum error of the curving mechanism was as small as 7 mm and the standard deviation of the bending mechanism was just 1.6°. In the experiments using a fetus model, the manipulator could be well controlled under ultrasound guidance and its curving mechanism with the balloon-based stabilizer could be clearly visualized during the implementation of fetus model supporting. The manipulator has the potential to be used in minimally invasive intrauterine surgery, though further improvements and experiments remain to be carried out.

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Myelomeningocele Repair: Technical Considerations and Complications

Cited by 21 publications

References 17 publications

Delayed CSF Pseudocyst following Shunt Malfunction after Myelomeningocele Repair.

Delayed CSF Pseudocyst following Shunt Malfunction after Myelomeningocele Repair.

Malformação de Chiari do tipo II sintomática

Fetus Support Manipulator with Flexible Balloon-Based Stabilizer for Endoscopic Intrauterine Surgery

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