Myelomeningocele Repair

2021 ◽  
pp. 137-151
Author(s):  
William Whitehead ◽  
Titilopemi Aina
2013 ◽  
Vol 217 (S 01) ◽  
Author(s):  
M Meuli ◽  
U Moehrlen ◽  
A Flake ◽  
N Ochsenbein-Kölble ◽  
M Huesler-Charles ◽  
...  

2020 ◽  
Author(s):  
R Zupan ◽  
M Meuli ◽  
U Möhrlen ◽  
L Mazzone ◽  
F Krähenmann ◽  
...  

2021 ◽  
Vol 267 ◽  
pp. 660-668
Author(s):  
Jordan E Jackson ◽  
Christopher Pivetti ◽  
Sarah C Stokes ◽  
Christina M Theodorou ◽  
Priyadarsini Kumar ◽  
...  

Author(s):  
Antonio Macedo ◽  
Sérgio Leite Ottoni ◽  
Gilmar Garrone ◽  
Antonio Moron ◽  
Sergio Cavalheiro ◽  
...  

2001 ◽  
Vol 98 (4) ◽  
pp. 698-701
Author(s):  
George C. Lu ◽  
Jon Steinhauer ◽  
Patrick S. Ramsey ◽  
Ona Faye-Petersen

2016 ◽  
Vol 18 (4) ◽  
pp. 416-422 ◽  
Author(s):  
Jacob Cherian ◽  
Kristen A. Staggers ◽  
I-Wen Pan ◽  
Melissa Lopresti ◽  
Andrew Jea ◽  
...  

OBJECTIVE Due to improved nutrition and early detection, myelomeningocele repair is a relatively uncommon procedure. Although previous studies have reviewed surgical trends and predictors of outcomes, they have relied largely on single-hospital experiences or on databases centered on hospital admission data. Here, the authors report 30-day outcomes of pediatric patients undergoing postnatal myelomeningocele repair from a national prospective surgical outcomes database. They sought to investigate the association between preoperative and intraoperative factors on the occurrence of 30-day complications, readmissions, and unplanned return to operating room events. METHODS The 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (NSQIP-P) was queried for all patients undergoing postnatal myelomeningocele repair. Patients were subdivided on the basis of the size of the repair (< 5 cm vs > 5 cm). Preoperative variables, intraoperative characteristics, and postoperative 30-day events were tabulated from prospectively collected data. Three separate outcomes for complication, unplanned readmission, and return to the operating room were analyzed using univariate and multivariate logistic regression. Rates of associated CSF diversion operations and their timing were also analyzed. RESULTS A total of 114 patients were included; 54 had myelomeningocele repair for a defect size smaller than 5 cm, and 60 had repair for a defect size larger than 5 cm. CSF shunts were placed concurrently in 8% of the cases. There were 42 NSQIP-defined complications in 31 patients (27%); these included wound complications and infections, in addition to others. Postoperative wound complications were the most common and occurred in 27 patients (24%). Forty patients (35%) had at least one subsequent surgery within 30 days. Twenty-four patients (21%) returned to the operating room for initial shunt placement. Unplanned readmission occurred in 11% of cases. Both complication and return to operating room outcomes were statistically associated with age at repair. CONCLUSIONS The NSQIP-P allows examination of 30-day perioperative outcomes from a national prospectively collected database. In this cohort, over one-quarter of patients undergoing postnatal myelomeningocele repair experienced a complication within 30 days. The complication rate was significantly higher in patients who had surgical repair within the first 24 hours of birth than in patients who had surgery after the 1st day of life. The authors also highlight limitations of investigating myelomeningocele repair using NSQIP-P and advocate the importance of disease-specific data collection.


2011 ◽  
Vol 7 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Ryan A. Grant ◽  
Gregory G. Heuer ◽  
Geneive M. Carrión ◽  
N. Scott Adzick ◽  
Erin S. Schwartz ◽  
...  

Object Myelomeningocele (MMC) is characterized by a defect in caudal neurulation and appears at birth with a constellation of neuroanatomical abnormalities, including Chiari malformation Type II. The authors investigated the effects of antenatal versus postnatal repair of MMC through a quantitative analysis of morphometric changes in the posterior fossa (PF). Methods The authors retrospectively reviewed the records of 29 patients who underwent in utero MMC repair, 24 patients who underwent postnatal repair, and 114 fetal and pediatric controls. Tonsillar displacement, cerebellum length, pons length, clivus-supraocciput (CSO) angle, and PF area were compared in antenatal and postnatal MMC repair groups as well as in controls without neural tube defects by using t-tests and correlation coefficients. Results Initially, the in utero CSO angle was significantly more acute in all patients with MMC—prenatally and postnatally repaired—as compared with controls (57.8° vs 75.4°, p < 0.001); however, the angle rapidly changed and became similar to that in controls between 30 and 31 weeks' gestation to approximately 80°, with antenatal repair having little effect. Postnatally, the CSO angle decreased in controls (R = −0.58) and in the antenatal repair group (R = −0.17). The cerebellum and pons length demonstrated no significant differences in any group. Overall, tonsil descent was corrected in the antenatal repair group as compared with postnatal repair (p < 0.001), and the PF area increased in all 3 groups in utero. Growth was less rapid in patients with MMC compared with controls, but this was corrected by antenatal repair (p = 0.015). Conclusions Myelomeningocele was associated with tonsillar herniation and a smaller PF than in control fetuses. Antenatal surgical repair corrected both abnormalities. The CSO angle began significantly more acutely in patients with MMC, but normalized with development regardless of when surgery was performed. Determining the clinical effects of antenatal repair requires further follow-up.


2018 ◽  
Vol 46 (3) ◽  
pp. 153-158 ◽  
Author(s):  
Franziska M. Winder ◽  
Ladina Vonzun ◽  
Martin Meuli ◽  
Ueli Moehrlen ◽  
Luca Mazzone ◽  
...  

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