• World Neurosurg · Feb 2023

    Case Reports

    Postnatal Surgical Correction of Myelomeningoceles: Pre- and Intraoperative Risk Factors Associated with Postoperative Neurological Outcomes.

    • Enrique Acosta-Medina, Oscar F Zorro-Guío, Nadin J Abdala-Vargas, Lorena Jacomussi-Alzate, Luisa F Figueredo, Jason M Johnson, Javier G Patiño-Gómez, and Edgar G Ordóñez-Rubiano.
    • Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia.
    • World Neurosurg. 2023 Feb 1; 170: e629e638e629-e638.

    ObjectiveOpen spina bifida or myelomeningocele (MMC) is a congenital defect that results from failure of caudal neurulation. We present a case series of patients who were treated with postnatal surgical correction for MMC, evaluating the possible preoperative and intraoperative risk factors associated with neurologic outcomes.MethodsA retrospective chart review of patients who underwent postnatal surgical correction for MMCs over 11 years at our institution was performed. MMCs were classified based on their morphologic configuration into 3 types. Type I includes defects without a sac and there is cerebrospinal fluid (CSF) leak. Type II includes where there is a sac ≤4 cm, with or without CSF leak. Type III includes defects with a sac that are greater than 4 cm.ResultsFifty patients were included. The median age of gestation at surgery was 37.4 weeks. There were 30 females (60%). All mothers received adequate folate supplementation. All patients underwent surgical correction in the first 48 hours. Lower extremity motor function at the last clinical follow-up was normal in 34 patients (68%). CSF leak, infection, and mortality were 8%, 2%, and 0%, respectively. Twenty-one patients (42%) underwent ventriculoperitoneal shunt for hydrocephalus.ConclusionsDespite there being no statistically significant associations with a timely closure, all cases were treated within the first 48 hours and this could influence the low complication rate. Individuals of Hispanic background who received appropriate folate supplementation still had high rates of MMC and we posit that this may be caused in part by a genetic/molecular predisposition.Copyright © 2022 Elsevier Inc. All rights reserved.

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