Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10467, USA.
School of Medicine, Department of Neurosurgery, Emory University, Atlanta, USA.
Childs Nerv Syst. 2024 Nov;40(11):3621-3628. doi: 10.1007/s00381-024-06584-5. Epub 2024 Oct 2.
Myelomeningocele (MMC) is a severe form of spina bifida characterized by spinal cord extrusion into a cerebrospinal fluid (CSF) filled sac which may lead to lifelong disability. Repair of these lesions have classically occurred shortly after birth, but more recently, prenatal myelomeningocele repair techniques have been elucidated. This study aimed to investigate the outcome of surgery, particularly with subsequent spinal cord tethering, in patients with prenatal myelomeningocele closure and those with postnatal repair surgery.
In this retrospective study which assessed patients from April 2002 to April 2020, the data of 18 total patients with MMC were reviewed. Nine patients from each group were included, closed prenatally or postnatally, respectively. Demographic information including age and sex, birth week, infant comorbidities, presence of dermoid or lipoma, cutaneous stigmata, total number and timing of detethering procedures, presence of Chiari malformation, and need for VPS was obtained.
Eighteen patients including nine infants closed prenatally and nine infants with myelomeningoceles closed postnatally were reviewed. The mean age was 4 ± 3 years and 6.22 ± 2.4 in prenatal and postnatal retrospectively. There was a significant relationship between the number of detethering procedures (p-value = 0.03) and the need for a ventriculoperitoneal shunt (VPS) (p-value = 0.01) between the groups, with the prenatal closure group having lower rates of each. There was no significant difference between the groups in regard to the mean age at the detethering procedure (p = 0.4), sex (p = 0.09), birth week (p = 0.8), comorbidities (p = 0.8), presence of intraspinal dermoid or lipoma (p = 0.09), presence of cutaneous stigma (p = 0.08), Chiari (p = 0.6), fatty filum (p = 0.08), syrinx (p = 0.4), bone anomaly (p = 0.4), and spina bifida neurological scale (p = 0.66).
There was a significant relationship between the two groups in terms of the number of detethering procedures, and the need for VPS. Our data represents a possible difference in the need for detethering surgeries and ventriculoperitoneal shunt placements between patients with prenatal and postnatal myelomeningocele closures.
脊髓脊膜膨出（MMC）是一种严重的脊柱裂形式，其特征是脊髓挤出到充满脑脊液（CSF）的囊中，这可能导致终身残疾。这些病变的修复传统上发生在出生后不久，但最近，已经阐明了产前脊髓脊膜膨出修复技术。本研究旨在研究手术结果，特别是在接受产前脊髓脊膜膨出闭合和产后修复手术的患者中进行的后续脊髓拴系松解术。
在这项回顾性研究中，评估了 2002 年 4 月至 2020 年 4 月期间的 18 名 MMC 患者的数据，分别纳入了 9 名接受产前和 9 名接受产后闭合的患者。收集了人口统计学信息，包括年龄和性别、出生周、婴儿合并症、皮样瘤或脂肪瘤的存在、皮肤标志、松解术的总次数和时间、Chiari 畸形的存在以及 VPS 的需求。
共纳入 18 名患者，其中 9 名婴儿接受了产前闭合，9 名婴儿接受了产后闭合。平均年龄分别为 4±3 岁和 6.22±2.4 岁。在松解术的次数（p 值=0.03）和对脑室腹腔分流术（VPS）的需求（p 值=0.01）方面，产前闭合组的发生率较低，这两组之间存在显著关系。在松解术的平均年龄（p=0.4）、性别（p=0.09）、出生周（p=0.8）、合并症（p=0.8）、脊髓内皮样瘤或脂肪瘤的存在（p=0.09）、皮肤标志的存在（p=0.08）、Chiari 畸形（p=0.6）、脂肪性马尾（p=0.08）、脊髓空洞症（p=0.4）、骨异常（p=0.4）和脊柱裂神经学量表（p=0.66）方面，两组之间无显著差异。
在松解术的次数和对 VPS 的需求方面，两组之间存在显著关系。我们的数据表明，产前和产后脊髓脊膜膨出闭合患者在需要松解手术和脑室腹腔分流术放置方面可能存在差异。
