Delayed repair of myelomeningoceles
Joseph C Watson1, Gary Tye1, John D Ward1
1Harold F. Young Neurosurgical Center, Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Insights
Delayed surgical repair of myelomeningocele (a birth defect) in children is possible, even with epithelialized sacs. Lessons from surgical missions inform these challenging neurosurgical procedures.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Birth Defects Research
Background:
- Myelomeningocele is a severe neural tube defect requiring early surgical intervention to prevent meningitis.
- Delayed presentation of myelomeningocele can lead to an epithelialized sac, posing unique surgical challenges.
- Standard surgical techniques may be insufficient for repairing neglected myelomeningoceles.
Purpose of the Study:
- To describe surgical techniques for delayed repair of myelomeningocele.
- To share insights gained from managing epithelialized myelomeningocele cases.
- To inform neurosurgical approaches for complex, unrepaired myelomeningoceles.
Main Methods:
- Retrospective analysis of 97 patients undergoing delayed repair (>6 months) of myelomeningocele over 10 years.
- Presentation of specific repair techniques used in a challenging case of unrepaired myelomeningocele.
- Experience derived from surgical missions in Guatemala.
Main Results:
- Successful surgical reduction and closure techniques were developed for epithelialized myelomeningoceles.
- The study highlights modifications to standard closure techniques necessary for delayed repairs.
- Surgical outcomes were informed by extensive clinical experience.
Conclusions:
- Delayed closure of myelomeningocele is a viable option when primary repair is not feasible.
- Surgical experience, particularly from resource-limited settings, enhances techniques for complex cases.
- Effective management of neglected myelomeningocele relies on adapted neurosurgical approaches.
Objective:
Myelomeningocele is a defect that typically is repaired surgically within the first few days of life in developed countries to minimize the risk of meningitis. If left unrepaired, these children may survive to have their meningocele sac epithelialize. The surgical reduction and closure of an epithelialized myelomeningocele represents a unique challenge for the neurosurgeon because it requires a modification of the typical closure technique.
Methods:
Our 10 years' experience in 97 patients with the delayed (>6 months) repair of myelomeningoceles formed the basis of this report.
Results:
We present repair techniques in a child with a myelomeningocele that was not repaired at birth and presented a surgical challenge.
Conclusion:
Delayed closure of myelomeningoceles is facilitated by lessons learned from our surgical experience during a medical missions to Guatemala.
