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Clinical features and MR imaging in children with repaired myelomeningocele
1Divisione Neurologia dello Sviluppo, Istituto Nazionale Neurologico C. Besta, Milano.
Abstract:
The aim of the study is to define the role of associated malformations in the clinical evolution of children affected by myelomeningocele. MRI investigation of the spinal cord was carried out on 25 patients between the age of 7.3 and 18.10 with MMC repaired and followed up for at least 7 years. The relation between associated malformations demonstrated by MRI and clinical trend was analysed. The results are the following: 1) presence of asymptomatic tethered cord in all cases; 2) high frequency (92%) of Chiari malformation; 3) presence of syringomyelia in 20% of patients, symptomatic in 1; 4) presence of ventricular enlargement in 72% of cases without increased intracranial pressure syndrome. For a better therapeutic approach prospective MRI studies are needed in order to follow up associated malformations.
Insights
Associated malformations significantly impact myelomeningocele (MMC) clinical outcomes. MRI reveals high rates of Chiari malformation and tethered cord, influencing patient prognosis and requiring further study.
Area of Science:
- Neuroscience
- Pediatric Surgery
- Medical Imaging
Background:
- Myelomeningocele (MMC) is a complex congenital condition requiring long-term management.
- Associated malformations can significantly influence the clinical trajectory of affected children.
- Understanding these associations is crucial for optimizing patient care.
Purpose of the Study:
- To elucidate the role of associated malformations in the clinical evolution of pediatric myelomeningocele patients.
- To correlate findings from spinal cord Magnetic Resonance Imaging (MRI) with clinical outcomes.
- To identify key malformations impacting long-term prognosis.
Main Methods:
- Retrospective analysis of 25 myelomeningocele patients (ages 7.3-18.10) with repaired MMC and >7 years follow-up.
- Spinal cord MRI investigations to identify associated malformations.
- Correlation of MRI findings with clinical trends and patient evolution.
Main Results:
- All patients exhibited asymptomatic tethered cord.
- Chiari malformation was present in 92% of cases.
- Syringomyelia occurred in 20% (1 symptomatic case); ventricular enlargement in 72% without increased intracranial pressure.
Conclusions:
- Associated malformations, particularly Chiari malformation and tethered cord, are highly prevalent in myelomeningocele patients.
- These findings underscore the importance of comprehensive MRI assessment for understanding clinical progression.
- Prospective MRI studies are recommended for monitoring malformations and guiding therapeutic strategies.