Evaluation and Management of Lumbosacral Myelomeningoceles in Children.

Abstract

Myelomeningoceles are the common form of open neural tube defects that are usually associated with neurological deficits. Many techniques of repair and methods of prevention have been proposed with respect to the size of defect and the neurological condition of patient. The aim of this study was to report our experience on the management of lumbosacral myelomeningoceles in children. We retrospectively analysed the data of 36 paediatric cases of surgically lumbosacral myelomeningocele treated in our department between 1998 and 2013. Twenty (56%) patients were female and sixteen were male, with a mean age of 4 months (ranged between 0 and 24 months). All patients had neurological deficits in the preoperative period. Computed tomography was performed in 33 (92%) patients and magnetic resonance imaging in 15 (42%) patients in the preoperative period. Repair of the myelomeningocele and closure of the skin defect were performed in all patients. The mean follow-up period was 36 months. Thirty (83%) patients were operated for hydrocephalus and 10 (28%) patients were re-operated for tethered cord syndrome during the follow-up period. Neurological worsening was not observed in any patient while cerebrospinal fluid fistula was detected in 2 patients. Surgical treatment using appropriate microsurgical techniques is crucial for lumbosacral myelomeningoceles in children. Early surgical intervention with close follow-up will improve the neurological condition of the patients.