Management of myelomeningocele

ABSTRACT

T To find out best possible protocol to provide productive life to children born with Myelomeningocele. Descriptive study. Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi from December 2001 to December 2006. The medical record of 415 children with myelomeningocele operated at our center was reviewed retrospectively. The surgical and medical management protocol used for different sites of myelomeningocele was studied.The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All paraplegic patients with dorsolumbar myelomeningocele were treated with either a low-pressure ventriculoperitoneal [VP] shunt only, direct repair or both. Patients with cervical, dorsal and lumbo-sacral myelomeningocele requiring VP shunt were operated either simultaneously for both procedures or with delayed insertions of a VP shunt after treatment of ventriculitis All 16 patients with ruptured myelomeningocele [3.8%] were treated for repair as well as ventriculitis. Complications including CSF leak, wound infection or necrosis after repair of myelomeningocele occurred in 22 cases [5.3%]. The postoperative follow up for all patients was 1- 2 years Surgical intervention with a low-pressure VP shunt in large dorsolumbar myelomeningocele produced good results: