Extended latissimus dorsi musculocutaneous flap for closure of a meningomyelocele in a 5-hour-old neonate

Neurosurgical management of patients with lumbosacral myeloschisis

Myeloschisis is the most serious and complex congenital anomaly in spina bifida manifesta (cystica). However, with improvements in medical care and increased understanding of its pathophysiology, the associated long-term morbidity and mortality rates have been significantly reduced. This article reviews various issues associated with the neurosurgical management of patients with myeloschisis, such as perinatal management, repair surgery for myeloschisis, neurosurgical management of hydrocephalus, Chiari malformation type II, tethered cord syndrome and epilepsy, and intrauterine fetal surgery.

Outcome of myelomeningocoele repair in sub-Saharan Africa: the Nigerian experience

OBJECTIVE

Early repair of myelomeningocoele (MM) is associated with decreased morbidity and mortality. In sub-Saharan Africa, the peculiar harsh economic and social realities make late presentation, malnutrition and sepsis at presentation prevalent. As these factors may affect surgical repair, the aim of this study was to review the outcome of repair of MM in this peculiar patient population.

MATERIALS AND METHODS

A prospective study of patients with MM who presented at the Lagos State University Teaching Hospital, Lagos, Nigeria over a 12 month period was studied. Follow up ranged from 8 weeks to 1 year.

RESULTS

Five patients died while awaiting surgery. Thirty-six patients, 24 males and 12 female infants with MM were operated on during the study period. Majority of the patients were operated on or after the seventh day of life. The median age at surgery was 11th day of life (range second day-2 years). The mean surface area of the myelomeningocoele was 26.4 cm(2) (range 12.6-62.9 cm(2)). The post-operative morbidity and mortality was five and one, respectively.

CONCLUSIONS

Intracranial sepsis is the main cause of death in MM patients who are not operated on time. The patients we are seeing are probably those that survived to present at the hospital; by that time primary closure is usual without the need for complex plastic procedures. Delay in presentation even with associated malnutrition and local sepsis seems not to significantly affect the outcome of MM repair.

Primary closure of open myelomeningocele

OBJECT

The purpose of this paper is to describe the technique of closing an open myelomeningocele in the newborn infant.

METHODS

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.

CONCLUSIONS

A multidisciplinary team approach is critical to the long-term management of these patients.