Holder M, Köhler B, Wörle H, Keimer R, Tzonos T
Olgahospital, Pädiatrisches Zentrum, Kinderklinik, Stuttgart.
Monatsschr Kinderheilkd. 1993 Apr;141(4):308-15.
Both the use of a selective policy of treatment of newborns with myelomeningocele and the right time of back closure are still controversially discussed. We report our experiences in the long-term care of children with myelomeningocele.
103 newborns with myelomeningocele (n = 94) and meningocele (n = 9) born 1980 to 1990 and cared for regularly at the Olgahospital's pediatric clinic were followed up from the neuropediatric-neurosurgical point of view. Postpartum we predominantly practised a selective policy of treatment.
15 of 21 children (71.4%) not operated on died during the first days or months of life, 6 (28.6%) survived. 70 were operated selectively, of which 9 (12.9%) died, 61 (87.1%) survived with mainly good result. There were no differences in the survival rate and frequency/type of postoperative complications with respect to the time of the back closure. 31 children with myelomeningocele (33%) had CNS anomalies other than the Arnold-Chiari-Malformation, mostly being a dys- or aplasia of the corpus callosum and a deformed ventricle system. These were diagnosed almost exclusively by CT or MRT scan.
We still predominantly practised a selective policy of treatment of newborns with myelomeningocele with mainly good results.
对于患有脊髓脊膜膨出的新生儿采用选择性治疗策略以及背部闭合的合适时机，目前仍存在争议。我们报告我们在脊髓脊膜膨出患儿长期护理方面的经验。
对1980年至1990年出生并在奥尔加医院儿科诊所定期接受护理的103例患有脊髓脊膜膨出（n = 94）和脊膜膨出（n = 9）的新生儿，从神经儿科 - 神经外科角度进行随访。产后我们主要采用选择性治疗策略。
21例未接受手术的患儿中有15例（71.4%）在生命的最初几天或几个月内死亡，6例（28.6%）存活。70例接受了选择性手术，其中9例（12.9%）死亡，61例（87.1%）存活，且大多效果良好。在背部闭合时间方面，存活率以及术后并发症的发生率/类型没有差异。31例脊髓脊膜膨出患儿（33%）除了阿诺德 - 奇亚里畸形外还存在其他中枢神经系统异常，主要是胼胝体发育不全或发育异常以及脑室系统畸形。这些几乎完全通过CT或磁共振成像扫描诊断出来。
我们仍然主要对患有脊髓脊膜膨出的新生儿采用选择性治疗策略，且大多效果良好。
