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Retrospective analysis of early- and late-operated meningomyelocele patients
M Özgür Taşkapılıoğlu1, Bilge Türedi2, Oğuz Altunyuva3
1Department of Neurosurgery, Uludag University School of Medicine, Bursa, Turkey. ozgurt@uludag.edu.tr.
Purpose:
Myelomeningocele (MMC) is one of the commonest congenital malformations. Hydrocephalus develops in 65-85% of cases with MMC. Only 3-10% of MMC patients have normal urinary continence. We aim to investigate the effects of early and late operation in MMC patients in terms of development of hydrocephalus, motor deficits, and bladder functions.
Methods:
Medical records of MMC patients operated between January 2008 and December 2014 were reviewed retrospectively.
Results:
We retrospectively investigated patients' records of 43 patients. Twenty of the patients were operated within the first 48 h after the delivery (early repair group), while 23 of the patients were operated after 48 h of delivery (late repair group). In the early repair group, 15 patients were operated due to hydrocephalus. Urodynamic problems were detected in 17 (85%) patients. In the late repair group, shunts were placed in 14 (61%) patients during follow-up period and urodynamic problems were detected in 19 (82.6%) patients. Mean operation time for the late group was 4.6 months. There was no statistical difference between the early and late group in terms of neurological and urodynamic deficits. The mean follow-up period was 45.5 months.
Conclusion:
In the literature, surgery in the first 48 h of life is recommended for MMC patients. There was no difference between the early- and late-operated groups by means of hydrocephalus, urodynamic functions, and motor deficits in our study. Late surgery of intact sacs may avoid complications related to surgery in the neonatal period.
Insights
Early versus late surgical repair for myelomeningocele (MMC) showed no significant differences in hydrocephalus, motor deficits, or bladder function outcomes. Late surgery may help avoid neonatal complications.
Area of Science:
- Pediatric Surgery
- Neuroscience
- Urology
Background:
- Myelomeningocele (MMC) is a common congenital malformation with high rates of hydrocephalus (65-85%) and urinary incontinence (90-97%).
- Optimal surgical timing for MMC remains a subject of clinical debate.
Purpose of the Study:
- To investigate the impact of early (<48 hours) versus late (>48 hours) surgical repair on the development of hydrocephalus, motor deficits, and bladder function in MMC patients.
- To compare outcomes between early and late surgical intervention groups.
Main Methods:
- Retrospective review of medical records for 43 myelomeningocele patients operated between January 2008 and December 2014.
- Patients were divided into two groups: early repair (within 48 hours) and late repair (after 48 hours).
- Outcomes assessed included hydrocephalus requiring shunting, urodynamic problems, and motor deficits, with a mean follow-up of 45.5 months.
Main Results:
- No statistically significant difference was observed between the early and late repair groups regarding neurological deficits and urodynamic problems.
- In the early repair group, 15 patients required hydrocephalus surgery, and 85% had urodynamic problems.
- In the late repair group, 61% required shunts, and 82.6% had urodynamic problems, with a mean operation time of 4.6 months.
Conclusions:
- This study found no significant difference in hydrocephalus, urodynamic functions, or motor deficits between early and late surgical repair groups for myelomeningocele.
- Late surgical repair of intact myelomeningocele sacs may offer an advantage by potentially avoiding complications associated with neonatal surgery.
- Current literature recommends early surgery, but these findings suggest reconsidering the optimal timing based on specific clinical scenarios.
