Relationship Between Defect Volume and Comorbid Pathologies in Patients Undergoing Surgery for Myelomeningocele

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Radiology

Background:

• Myelomeningocele (MMC) is a complex congenital condition requiring surgical intervention.
• Hydrocephalus and Chiari malformation type 2 (CM) are common comorbidities associated with MMC.
• Radiological assessment of MMC sac volume is crucial for understanding disease severity and predicting outcomes.

Purpose of the Study:

• To determine myelomeningocele sac volume using radiological examinations.
• To investigate the relationship between sac volume, hydrocephalus, and Chiari malformation type 2 (CM).
• To inform optimal follow-up duration and treatment strategies for MMC patients.

Main Methods:

• Retrospective review of 81 patients undergoing myelomeningocele surgery (2015-2022).
• Measurement of MMC sac volumes from radiological examinations.
• Statistical analysis of sac volume correlation with Evans Index (EI) and CM presence.

Main Results:

• A strong positive correlation (r=0.622, p < 0.001) was found between MMC sac volume and the Evans Index.
• Ventriculomegaly (EI > 0.405) was present in 60.5% of patients.
• Patients with comorbid CM had significantly larger mean sac volumes (28,297.36 mm³) compared to those without CM (7,600.32 mm³).

Conclusions:

• Larger myelomeningocele sac volumes are associated with a higher risk of hydrocephalus, both pre-existing and post-operative.
• Patients with larger sac volumes and/or comorbid CM necessitate more frequent and extended follow-up.
• Consideration for same-session intervention is recommended for patients with larger sac volumes.