Sattar M Hashim, Shahid Ahmed, Rashid Jooma.
Management of Myelomeningocele.
J Surg Pak Jan ;13(1):7-11.

Objective: To find out best possible protocol to provide productive life to children born with myelomeningocele. Study Design: Descriptive study Place and Duration of study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi from December 2001 to December 2006. Patients and Methods: The medical record of 415 children with myelomeningocele operated at our center was reviewed retrospectively. The surgical & medical management protocol used for different sites of myelomeningocele was studied. Results: The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All paraplegic patients with dorsolumbar myelomeningocele were treated with either a low-pressure ventriculoperitoneal (VP) shunt only, direct repair or both. Patients with cervical, dorsal and lumbo-sacral myelomeningocele requiring VP shunt were operated either simultaneously for both procedures or with delayed insertions of a VP shunt after treatment of ventriculitis. All 16 patients with ruptured myelomeningocele (3.8%) were treated for repair as well as ventriculitis. Complications including CSF leak, wound infection or necrosis after repair of myelomeningocele occurred in 22 cases (5.3%). The postoperative follow up for all patients was 1- 2 years. Conclusion: Surgical intervention with a low-pressure VP shunt in large dorsolumbar myelomeningocele produced good results.

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