Risk factors, presentation and outcome of meningomyelocele repair

Meningomyelocele repair

  • Lal Rehman, Professor Jinnah Postgraduate Medical Center
  • Munwar Sheikh, Fellow Jinnah Postgraduate Medical Center
  • Ali Afzal Jinnah Postgraduate Medical Center
  • Raza Rizvi, Professor Jinnah Postgraduate Medical Center
Keywords: Meningomyelocele, Neural Tissue, Maternal folate intake, MMC repair

Abstract

Objective: To determine the risk factors, presentation and outcome of meningomyelocele repair

Methods: We reviewed 150 cases operated for meningomyelocele (MMC) at Jinnah Postgraduate Medical Centre Karachi between May 2015 and May 2018. Data of infants operated for MMC repair was extracted including socioeconomic status, maternal folate intake during pregnancy, head circumference, location and width of the defect, accompanying bladder and limb anomalies and treatments administered. Patients were followed up for a mean period of six months.

Results: A total of 150 children were evaluated, out of which there were 83(55.3%) males and 67(44.7%) females. All belonged to low socio economic group and prenatal maternal folate intake as risk factor was positive in 103(68.7%) cases. Mean head circumference was 37.4 cm (range, 30.7 to 50 cm). Based on their location, 83(55%) of the defects were lumbosacral, 38(25.4%) were lumbar, 16(10.7%) were thoraco lumbar, 10(6.7%) were thoracic and three (2%) were cervical. Mean size of the meningomyelocele sac was 4.3 cm×5.6 cm (range, 1cm×2cm to 11cm×8.4cm) and 21(14%) of the babies had a skin defect requiring flap. According to accompanying anomalies, 98(65.3%) of the babies had hydrocephalus, 13(9%) had club foot, four (2.7%) had diastematomyelia and three (2%) had tethered cord. Eighty seven (58%) patients had neurological deficit pre operatively and eight (5.4%) patients with normal power deteriorated after surgery out of which five (3.3%) developed paraplegia and three (2%) developed paraparesis. CSF leak was the major complication encountered in 16(11%) followed by meningitis in seven (5%), while the overall mortality was four (2.6%).

Conclusion: The practice of periconceptional folic acid supplementation is essential to reduce the prevalence of neural tube defects (NTDs) in the developing world. Improved maternal nutrition with access to quality antenatal care is vital to decrease the prevalence and health burden.

doi: https://doi.org/10.12669/pjms.36.3.1237

How to cite this:
Rehman L, Shiekh M, Afzal A, Rizvi R. Risk factors, presentation and outcome of meningomyelocele repair. Pak J Med Sci. 2020;36(3):422-425. doi: https://doi.org/10.12669/pjms.36.3.1237

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Lal Rehman, Professor, Jinnah Postgraduate Medical Center

Professor and Program DIrector

Department of Neurosurgery

Jinnah Postgraduate Medical Center

Karachi

Munwar Sheikh, Fellow, Jinnah Postgraduate Medical Center

Fellow

Department of Neurosurgery

Jinnah Postgraduate Medical Center

Karachi

Raza Rizvi, Professor, Jinnah Postgraduate Medical Center

Professor and Head of Department

Department of Neurosurgery

Jinnah Postgraduate Medical Center

Karachi

Published
2020-03-03
How to Cite
Rehman, L., Sheikh, M., Afzal, A., & Rizvi, R. (2020). Risk factors, presentation and outcome of meningomyelocele repair. Pakistan Journal of Medical Sciences, 36(3). https://doi.org/10.12669/pjms.36.3.1237
Section
Original Articles