Microsurgical treatment of myelomeningocele in the lumbar and sacral region in children:Report of 35 cases / 中国微创外科杂志

ABSTRACT

Objective To summarize and evaluate the experience and near-term outcomes of microsurgical treatment of myelomeningocele in the lumbar and sacral region in children.Methods Clinical data of 35 cases of myelomeningocele from October 2005 to November 2006 were analyzed retrospectively.The spinal cord and the cauda equine nerves were dissected microsurgically from the surrounding tissues.The duraplasty was performed and the thecal sac was reconstructed.The tight filums were released simultaneously in 8 cases and a ventriculoperitoneal shunt was placed in 10 children with severe hydrocephalus. Results The microsurgical repair was implemented and the spinal cord was released successfully in all the 35 cases.Among 10 cases of vesicorectal dysfunction,there were 3 cases of improvement of rectal sphincter functions after operation.Out of 9 cases of equinovarus,the tension of varus was decreased in 4 cases and no obvious functional improvement was observed in the rest of 5 cases.Leakage of cerebrospinal fluid from the incision occurred in 2 cases,and in the remaining cases the incision healed by first intention.The 10 cases of severe hydrocephalus were cured with ventriculoperitoneal shunting,including a delayed shunt insertion in 9 cases and a single-stage insertion in 1 case,in which a postoperative infection was encountered and a re-operation of ventriculoperitoneal shunting was given. Conclusions For children with myelomeningocele,a surgical treatment should be given as early as possible.A delayed shunt insertion 1~2 weeks after myelomeningocele repair is safe and effective.The duraplasty and optimized closure of the subcutaneous tissue are important for preventing cerebrospinal fluid leakage.