J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A051
DOI: 10.1055/s-0035-1566370

The Value of Postponing Repair in Large-Size Unruptured Myelomeningoceles

Amr K. El Samman 1, Omar M. El Falaky 1
  • 1Department of Neurosurgery, Cairo University Hospital, Cairo, Egypt

Introduction Myelomeningocele is an open neural tube defect. The incidence is 0.5 to 1 per 1,000 pregnancies in the United States. If left untreated, death usually occurs within the first year. Proper treatment by repair of the defect and management of hydrocephalus can lead to normal survival with or without neurological deficit. One of the troublesome issues in dealing with myelomeningocele repair is the skin closure owing to the relative shortage of skin needed for skin closure. Repairing the defect without having enough skin or closure with suture line under tension usually leads to skin dehiscence and stitches failure

Aim of the Work Studying the efficacy of management of Chiari II malformation by early insertion of a ventriculoperitoneal shunt and postponing the repair of the defect few months until there is enough skin for a normal proper closure.

Materials and Methods A total of 46 cases of myelomeningoceles were operated upon in children hospital of Cairo University Hospital. All cases presented immediately after birth. The size of the defect “D” (maximum width) and the width of the back of the infant “B” are measured from right to left flank. A ratio is calculated dividing the D over B. If the ratio is more than ⅓, a decision of postponing the repair is considered until this ratio is reached by physical growth of the baby.

Results A total of 46 cases of myelomeningocele were operated upon in the period between 2007 and 2014. Out of the 46 cases, 12 were fulfilling the ratio and hence were operated upon immediately. Thirty-four cases were large and repair was postponed for 2 to 4 months and then were operated upon. Thirty-nine cases had hydrocephalus and were operated upon by VP shunt. There were no cases of wound dehiscence in this series; however, two cases of superficial wound infection were encountered and managed conservatively.

Conclusion In large myelomeningocele, postponing the repair until there is enough skin for closure is safe and significantly reduces the wound dehiscence complications.

Keywords neural tube defects; myelomeningocele; Arnold–Chiari II