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

Abstract

Introduction: Children with myelomeningocele (MMC) are usually subjected to multiple surgeries. However, the number and type of surgeries are not the same in every patient with MMC over time. This report summarizes the surgical interventions in a cohort of several ages. Materials and methods: Data on all of the patients with MMC, aged from 1 year and 10 months to 21 years and 11 months, were retrospectively reviewed at the Dona Estefânia Hospital in Lisbon, Portugal. Data were collected by chart review and individual interviews. The factors analyzed were demographics, ambulatory status, neurological level of involvement, shunt status, Arnold-Chiari malformation type II, surgical history, and occurrence of fracture. The surgical interventions were categorized as neurosurgical, orthopedic, urinary, ulcer repair and others. Results: A total of 84 alive were eligible and enrolled. The average age was 14 years and six months. A total of 59 patients received shunts (all but one ventriculoperitoneal). In the study group, the 84 patients required 663 surgeries. Neurosurgical interventions were the most frequent surgical procedure and predominated during the first 2 years of life. Surgical interventions related to shunts were the most common neurosurgical interventions. Orthopedic surgeries were more frequent in the age group 6-12 years. Urological surgeries were done mainly after 6 years of age. Surgical repair of pressure ulcers was more common after 12 years of age. Conclusions: Our study brings to light the complexity of this condition, with multiple surgeries among patients with MMC.

A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa

“…Surgical repair of the MMC is generally performed within 24 h after birth to minimize the risk of infection and to preserve existing function in the spinal cord [7]. Most authors [11,17] concur that a surgical closure longer than 48 h after delivery is an important risk factor for wound sepsis and other complications, while others contend that the timing of MMC repair has no influence on complications [15][16][17]. In our setting, patients are referred for repair long after birth, which explains the late age of repair of 4.7 months in this study.…”

Long-term follow-up of superior gluteal artery perforator flap closure of large myelomeningoceles

“…For example, a long-term retrospective review found that sacral pressure ulcers in myelomeningocele patients were most commonly repaired after 12 years of age. 9 All patients who received a VP shunt did so based on the findings, clinical and/or radiographic, that were concerning for symptomatic hydrocephalus. We use rapid or abnormal head growth, sutural diastasis, progressive enlargement of ventricles on serial imaging studies, or feeding intolerance as criteria for shunt placement.…”

Update on bone fragility in spina bifida

“…Risk factors for the occurrence of fractures in SB include high levels of neurological involvement [6,7,9,10,18], patients in wheelchairs [6,7,13,28], the presence of hypercalciuria [15], the presence of contractures [18], and high body fat content and body mass index (BMI) values [15]. An association between secondary inactivity due to cast immobilization and/or operative orthopaedic procedures and the occurrence of fractures was detected [6][7][8][9][10][11][12]19,20,40]. The occurrence of a spontaneous first fracture increases the risk of a second fracture [7].…”

“…Children with SB may have unique predisposing factors to vitamin D deficiency, such as immobility and consequent decreased sun exposure, dietary limitations, and CKD [35,40,62,69,[75][76][77][78]. Dietary and metabolic factors include the intake of vitamin-D-rich foods and the association between obesity and 25-OHD levels, respectively [62,79,80].…”