Primary closure of open myelomeningocele

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this paper is to describe the technique of closing an open myelomeningocele in the newborn infant.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The anatomical rationale behind the closure techniques will be specifically reviewed. Avoidance of complications will be discussed. The management of unusual developmental anatomical abnormalities, such as the management of unusually large skin defects and kyphotic deformities will be discussed. Complications and the postoperative care will be reviewed and specifics regarding postoperative care will be summarized.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A multidisciplinary team approach is critical to the long-term management of these patients.</jats:p></jats:sec>

Investigation of a fetal mass — sacrococcygeal teratoma

“…This lesion presents as a predominantly cystic type of spina bifida where a sac, containing cerebrospinal fluid, protrudes posteriorly through an open neural tube defect. The defect occurs commonly in the lumbar and sacral areas, resulting in the formation of a cystic mass …”

“…The defect occurs commonly in the lumbar and sacral areas, resulting in the formation of a cystic mass. 15 Myelocystocele has also been suggested as a differential diagnosis for SCTs, with the major distinction in imaging features being the spinal dysraphia and 'continuity of the protruding sac with the spinal cord central canal' in myelocystoceles, which might only be identified on MRI. 14…”

Concepts in the neurosurgical care of patients with spinal neural tube defects: An embryologic approach

“…In MMC, the hot dog is figuratively split longitudinally and the split edges are pulled widely apart, elevated through a wide open vertebral arch that has similarly failed to close and is fused solidly to the skin edges in an ellipse shaped defect. The arachnoid and other dystrophic, malformed tissue can remain intact and trap CSF beneath it (Gaskill, ; McLone, ). The trapped fluid may take on mass effect and cause the defect to appear as a fluid filled pedunculated mass of variable size rather than open defect (Figure ).…”

“…Closure of the spinal defect : Closure is accomplished within 48 hr of birth whenever possible (Gaskill, ; Guthkelch, ). Many centers prefer to close as soon as possible once screening is accomplished but virtually all centers close within 48 hr.…”

Neurosurgical management of spina bifida: Research issues

“…The microneurosurgical closure technique involves the approximation of the lateral edges of the open neural pla-code in the midline to reconstitute the neural tube [McLone, 1980;Gaskill, 2004]. This creates an outer layer of pia mater around the previously open neural tissue, or placode.…”