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[Physical and mental development after early surgery of myeloceles]
Insights
This study on 143 spina bifida cystica patients found that while most children with hydrocephalus required shunts, intellectual development was largely within normal ranges, enabling varied educational paths.
Area of Science:
- Pediatric Surgery
- Neurology
- Developmental Pediatrics
Context:
- Focuses on myelomeningocele (spina bifida cystica) surgical outcomes.
- Investigates long-term follow-up (3-15 years) in 143 patients.
- Addresses associated hydrocephalus prevalence (88%).
Purpose:
- To evaluate the long-term outcomes of myelomeningocele operations.
- To assess the efficacy and necessity of ventriculo-atrial shunts.
- To analyze physical, intellectual, and social rehabilitation in affected children.
Summary:
- 143 myelomeningocele patients underwent surgery, with 88% developing hydrocephalus requiring shunts in 89% of cases, often within the first three months.
- 25% of survivors used wheelchairs, 7% had severe mental defects, and 90% experienced neurogenic bladder issues.
- Survival to age 13 was 65%; intellectual development, assessed by Hawik and Bühler-Hetzer tests, averaged within normal ranges (97 +/- 15-219 and 70% normal, respectively).
Impact:
- Highlights the significant need for shunts in hydrocephalus associated with spina bifida.
- Demonstrates that despite physical challenges, intellectual development can be near-normal, supporting educational integration.
- Provides crucial data for understanding the long-term prognosis and rehabilitation needs of children with spina bifida cystica.
Abstract:
These investigations are based on 143 myelocele operations (=93 % spina bifida cystica), with a follow-up period of 3-15 years. There was an associated hydrocephalus in 88%. In 114 (89%) of the children with hydrocephalus a ventriculo-atrial shunt was inserted. In three quarters of the cases this was done within the first three months of life. In general the chindren remained "shunt-dependent" and only in 9% was it possible to remove it later. Of the surviving children about 25% were restricted to a wheel-chair and of them 7% had severe mental defects. Their physical state as regards head growth,height and weight showed about 70% of average values. Neurogenic disturbances of bladder emptying were present in 90% of the children. The expectation of survival to age 13 was 65%. Using the Hamburg Wechsler Intelligence Test for Children (Hawik) the intellectual development showed an average of 97 +/- 15-219 With only a trifling deviation this corresponds to the normal mean. The Bühler-Hetzer test also showed normal values in 70%. All the children are able to receive some training, which ranged from special schools right up to grammar school. We have particularly gone into the problem of the social rehabilitation of these children.