Robert Kellogg1, Philip Lee2, Christopher P Deibert3, Zachary Tempel4, Nathan T Zwagerman5, Christopher M Bonfield6, Stephen Johnson2, Stephanie Greene2. 1. 1Advocate Children's Hospital, Park Ridge, Illinois. 2. 2Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. 3Department of Neurosurgery, Emory University, Atlanta, Georgia. 4. 4Mayfield Brain and Spine, Cincinnati, Ohio. 5. 5Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and. 6. 6Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Abstract
OBJECTIVE: The authors reviewed 20 years' experience with the surgical management of open myelomeningocele in a well-defined retrospective cohort from a single large academic medical center. Their goal was to define the characteristics of a modern cohort of children with myelomeningocele to allow for evidence-based decision-making for the treatment of these patients. METHODS: After IRB approval was obtained, the authors queried an operative database maintained by the Department of Neurological Surgery at Children's Hospital of Pittsburgh for patients who underwent closure of a myelomeningocele between 1995 and 2015. They identified 153 infants, and a retrospective chart review was performed. RESULTS: Eighty-eight percent of the patients required placement of a ventriculoperitoneal shunt, and 15% of these patients acquired shunt-related infections. Eighteen percent of patients underwent Chiari malformation type II (CM-II) decompression. Sixteen percent of patients underwent a tethered cord release. Three percent of patients died within the 1st year of life. Predictors of an early demise included poor Apgar scores, large head circumference, and need for early CM-II decompression. Functional motor outcome was slightly better than predicted by anatomical level of defect. CONCLUSIONS: Myelomeningoceles represent a severe birth defect with life-threatening complications. The authors provide long-term follow-up data and insight into factors that contribute to early death.
OBJECTIVE: The authors reviewed 20 years' experience with the surgical management of open myelomeningocele in a well-defined retrospective cohort from a single large academic medical center. Their goal was to define the characteristics of a modern cohort of children with myelomeningocele to allow for evidence-based decision-making for the treatment of these patients. METHODS: After IRB approval was obtained, the authors queried an operative database maintained by the Department of Neurological Surgery at Children's Hospital of Pittsburgh for patients who underwent closure of a myelomeningocele between 1995 and 2015. They identified 153 infants, and a retrospective chart review was performed. RESULTS: Eighty-eight percent of the patients required placement of a ventriculoperitoneal shunt, and 15% of these patients acquired shunt-related infections. Eighteen percent of patients underwent Chiari malformation type II (CM-II) decompression. Sixteen percent of patients underwent a tethered cord release. Three percent of patients died within the 1st year of life. Predictors of an early demise included poor Apgar scores, large head circumference, and need for early CM-II decompression. Functional motor outcome was slightly better than predicted by anatomical level of defect. CONCLUSIONS: Myelomeningoceles represent a severe birth defect with life-threatening complications. The authors provide long-term follow-up data and insight into factors that contribute to early death.
Entities:
Keywords:
CM-II = Chiari malformation type II; ETV = endoscopic third ventriculostomy; VP shunt; VPS = ventriculoperitoneal shunt; congenital; myelomeningocele; spina bifida