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Zimmermann N, Messerer M, Vandenbulcke A. Thoracolumbar myelocele repair: how I do it. Acta Neurochir (Wien) 2024; 166:270. [PMID: 38884665 PMCID: PMC11182806 DOI: 10.1007/s00701-024-06163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Myelocele is a rare form of open spina bifida. Surgical repair is recommended prenatally or in the first 48 h. In some cases, the repair may be delayed, and specific surgical factors need to be considered. METHOD We give a brief overview of the surgical anatomy, followed by a description of the surgical repair of a thoracolumbar Myelocele in an 11-month-old child. CONCLUSION Surgical repair of the Myelocele stabilizes the neurological status, prevents local and central nervous system infections. The understanding of Myelocele anatomy enables its removal while preserving as much healthy tissue as possible and restoring normal anatomy.
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Affiliation(s)
- Nathalie Zimmermann
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Vaud, Switzerland.
- Unit of Pediatric Neurosurgery, University Hospital of Lausanne, Lausanne, Vaud, Switzerland.
| | - Alberto Vandenbulcke
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Vaud, Switzerland
- Unit of Pediatric Neurosurgery, University Hospital of Lausanne, Lausanne, Vaud, Switzerland
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2
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Cohrs G, Blumenröther AK, Sürie JP, Synowitz M, Held-Feindt J, Knerlich-Lukoschus F. Fetal and perinatal expression profiles of proinflammatory cytokines in the neuroplacodes of rats with myelomeningoceles: A contribution to the understanding of secondary spinal cord injury in open spinal dysraphism. J Neurotrauma 2021; 38:3376-3392. [PMID: 34541905 DOI: 10.1089/neu.2021.0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The cellular and molecular mechanisms that presumably underlie the progressive functional decline of the myelomeningocele (MMC) placode are not well understood. We previously identified key players in posttraumatic spinal cord injury cascades in human MMC tissues obtained during postnatal repair. In this study we conducted experiments to further investigate these mediators in the prenatal time course under standardized conditions in a retinoic-acid-induced MMC rat model. A retinoic acid MMC model was established using time-dated Sprague-Dawley rats, which were gavage-fed with all-trans retinoic acid (RA; 60 mg/kg) dissolved in olive oil at E10. Control animals received olive oil only. Fetuses from both groups were obtained at E16, E18, E22. The spinal cords (SCs) of both groups were formalin-fixed or snap-frozen. Tissues were screened by real-time RT-PCR for the expression of cytokines and chemokines known to play a role in the lesion cascades of the central nervous system after trauma. MMC placodes exhibited inflammatory cells and glial activation in the later gestational stages. At the mRNA level, IL-1b, TNFa, and TNF-R1 exhibited significant induction at E22. IL1-R1 mRNA was induced significantly at E16 and E22. Double labeling experiments confirmed the costaining of these cytokines and their receptors with Iba1 (i.e., inflammatory cells), Vimentin, and Nestin in different anatomical SC areas and NeuN in ventral horn neurons. CXCL12 mRNA was elevated in control and MMC animals at E16 compared to E18 and E22. CX3CL1 mRNA was lower in MMC tissues than in control tissues on E16. The presented findings contribute to the concept that pathophysiological mechanisms, such as cytokine induction in the neuroplacode, in addition to the "first hit", promote secondary spinal cord injury with functional loss in the late fetal time course. Furthermore, these mediators should be taken into consideration in the development of new therapeutic approaches for open spinal dysraphism.
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Affiliation(s)
- Gesa Cohrs
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Dept. of Neurosurgery, Arnold-Heller-Straße 3, Kiel, Germany, 24105;
| | - Ann-Kathrin Blumenröther
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Jan-Philip Sürie
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Michael Synowitz
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Janka Held-Feindt
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Friederike Knerlich-Lukoschus
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany.,Asklepios Kinderklinik Sankt Augustin, 248587, Pediatric Neurosurgery, Sankt Augustin, Nordrhein-Westfalen, Germany;
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3
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Moussa M, Papatsoris AG, Chakra MA, Fares Y, Dabboucy B, Dellis A. Perspectives on urological care in spina bifida patients. Intractable Rare Dis Res 2021; 10:1-10. [PMID: 33614369 PMCID: PMC7882087 DOI: 10.5582/irdr.2020.03077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 12/12/2020] [Indexed: 02/05/2023] Open
Abstract
Spina bifida (SB) is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. SB can occur in two major forms of open SB or SB aperta and closed SB or SB occulta. Myelomeningocele (MMC), the most common neural tube defects (NTDs), occurs in approximately 1 in 1,000 births. Considering non-genetic factors, diminished folate status is the best-known factor influencing NTD risk. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated as a risk factor for NTDs. The primary disorder in the pathogenesis of MMC is failed neural tube closure in the embryonic spinal region. The clinical manifestation of SB depends on clinical type and severity. SB can be detected in the second trimester using ultrasound which will reveal specific cranial signs. The management of MMC traditionally involves surgery within 48 h of birth. Prenatal repair of MMC is recommended for fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria. Urological manifestations of SB include urinary incontinence, urolithiasis, sexual dysfunction, renal dysfunction, and urinary tract infection. Renal failure is among the most severe complications of SB. The most important role of the urologist is the management of neurogenic bladder. Medical management with clean intermittent catheterization and anticholinergic treatment is generally considered the gold standard of therapy. However, when this therapy fails surgical reconstruction become the only remaining option. This review will summarize the pathogenesis, risk factors, genetic contribution, diagnostic test, and management of SB. Lastly, the urologic outcomes and therapies are reviewed.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
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Janik K, Manire MA, Smith GM, Krynska B. Spinal Cord Injury in Myelomeningocele: Prospects for Therapy. Front Cell Neurosci 2020; 14:201. [PMID: 32714152 PMCID: PMC7340150 DOI: 10.3389/fncel.2020.00201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
Myelomeningocele (MMC) is the most common congenital defect of the central nervous system and results in devastating and lifelong disability. In MMC, the initial failure of neural tube closure early in gestation is followed by a progressive prenatal injury to the exposed spinal cord, which contributes to the deterioration of neurological function in fetuses. Prenatal strategies to control the spinal cord injury offer an appealing therapeutic approach to improve neurological function, although the definitive pathophysiological mechanisms of injury remain to be fully elucidated. A better understanding of these mechanisms at the cellular and molecular level is of paramount importance for the development of targeted prenatal MMC therapies to minimize or eliminate the effects of the injury and improve neurological function. In this review article, we discuss the pathological development of MMC with a focus on in utero injury to the exposed spinal cord. We emphasize the need for a better understanding of the causative factors in MMC spinal cord injury, pathophysiological alterations associated with the injury, and cellular and molecular mechanisms by which these alterations are induced.
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Affiliation(s)
- Karolina Janik
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Meredith A Manire
- Department of Obstetrics and Gynecology, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - George M Smith
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Barbara Krynska
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
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Blount JP, Bowman R, Dias MS, Hopson B, Partington MD, Rocque BG. Neurosurgery guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:467-477. [PMID: 33325414 PMCID: PMC7838965 DOI: 10.3233/prm-200782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Myelomeningocele (MMC) arises from an early neural developmental anomaly and results in a variety of structural abnormalities and associated functional neurologic deficits. As such, neurologic issues are central to virtually all clinical problems. Neurosurgical intervention strives to correct or improve these defects and prevent secondary complications. These interventions include closure of the open myelomeningocele and management (across the life span) of hydrocephalus, the Chiari II malformation (C2M) and tethered spinal cord (TSC). The development of pre-natal closure techniques and reports of improved outcome with in-utero closure (IUMC) have revolutionized the neurosurgical approach to myelomeningocele. Controversies remain surrounding patient selection, maternal risks, technique of IUMC (endoscopic vs. open) and long-term outcomes. However, real gains include reduced rates of hydrocephalus, modestly improved motor capabilities and reduction in C2M morbidity. For many decades, the cornerstone of treatment of hydrocephalus for many decades has been the placement and support of ventricular shunts. Endoscopic third ventriculostomy (ETV) with or without choroid plexus coagulation (ETV/CPC) is an appealing alternate strategy that avoids the morbidity and complications associated with shunts. The exact criteria for ETV-CPC candidacy and best metrics for outcome analysis remain active areas of debate and controversy. Similarly, neurosurgical management C2M, has centered upon the indications and clinical thresholds for performing posterior fossa surgical decompression. Tethered spinal cord management incorporates the diagnosis and surgical management of adhesions formed at the initial closure site, the consequent longitudinal traction related stress on the cord and the resulting neurologic signs and symptoms.
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Affiliation(s)
- Jeffrey P Blount
- Department of Neurosurgery, Alabama Children's Hospital and University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin Bowman
- Department of Neurosurgery, Lurie Children's Hospital of Chicago and Northwestern University College of Medicine, Chicago, IL, USA
| | - Mark S Dias
- Department of Neurosurgery, Penn State Hershey Children's Hospital and Penn State College of Medicine, Hershey, PA, USA
| | - Betsy Hopson
- Department of Neurosurgery, Alabama Children's Hospital and University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael D Partington
- Department of Neurosurgery, Children's Mercy Hospital and University of Kansas School of Medicine, Kansas City, KA, USA
| | - Brandon G Rocque
- Department of Neurosurgery, Alabama Children's Hospital and University of Alabama at Birmingham, Birmingham, AL, USA
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6
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Abstract
Spina bifida is a congenital disorder with incomplete closure of the spinal column due to a bony vertebral defect. The term spina bifida literally means cleft spine and is used as a generic term of spinal dysraphism (Greek: Raphe = seam). It is a midline defect that occurs during the embryonic period. The insufficient closure of one or more vertebral arches is the result of an incomplete junction of the neural tube. Depending on the extent of the neural tube defect, various types of spina bifida can be differentiated. Closed spinal dysraphisms, also known as spina bifida occulta, are solely characterized by a bony defect of the vertebral arch, whereas, spina bifida cystica (synonym: open spina bifida or spina bifida aperta) can be distinguished by a protruding cyst, containing either meninges or meninges in combination with spinal cord tissue and are defined as open spinal dysraphisms.
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Affiliation(s)
- R Mühl-Benninghaus
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.
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7
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Bevan R, Wilson-Jones N, Bhatti I, Patel C, Leach P. How much do plastic surgeons add to the closure of myelomeningoceles? Childs Nerv Syst 2018; 34:737-740. [PMID: 29222684 PMCID: PMC5856885 DOI: 10.1007/s00381-017-3674-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE This study reviews the outcomes of children undergoing myelomeningocele (MMC) repair in the paediatric neurosurgical department in Cardiff. These procedures are historically performed by paediatric neurosurgeons with occasional support from plastic surgeons for the larger lesions. We reviewed the postoperative outcomes over a 9-year period to assess the efficacy of having a plastic surgeon present at all MMC closures. METHODS Analysis of a prospectively collected database of all MMC closures performed at University Hospital Wales from April 2009 to August 2017 was used. Comparison was made with the published literature especially with regard to complications. RESULTS Thirty-one children, 13 males and 18 females, underwent MMC closure over the 9-year period. Twenty-four (77.4%) defects were closed by direct approximation. Seven patients (22.5%) required a more complex plastic procedure to obtain closure. Two patients (6.5%) had a wound complication, one wound infection and one flap edge necrosis both healing with dressings alone. Two patients had cerebrospinal fluid (CSF) leaks that responded to ventriculo-peritoneal shunting. Two patients died from unrelated conditions during the study period. CONCLUSION In our series, 7/31 (22.5%) cases involved a more complex closure in keeping with the literature. The authors feel that having the plastic surgeon at all closures has led to a low wound complication rate.
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Affiliation(s)
- Rhian Bevan
- University Hospital of Wales College of Medicine, Cardiff, UK.
| | | | - Imran Bhatti
- 0000 0001 0169 7725grid.241103.5Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Chirag Patel
- 0000 0001 0169 7725grid.241103.5Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Paul Leach
- 0000 0001 0169 7725grid.241103.5Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
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Houtrow AJ, Burrows PK, Thom EA. Comparing neurodevelopmental outcomes at 30 months by presence of hydrocephalus and shunt status among children enrolled in the MOMS trial. J Pediatr Rehabil Med 2018; 11:227-235. [PMID: 30507586 DOI: 10.3233/prm-170481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate for differences in neurodevelopmental outcomes at 30 months of age for children enrolled in the Management of Myelomeningocele Study (MOMS) based on the presence of hydrocephalus and cerebral shunts. METHODS Children with no hydrocephalus (N= 27), children with shunted hydrocephalus (N= 108), and children with unshunted hydrocephalus (N= 36) were compared at 30 months of age on the Bayley II Mental and Psychomotor Indices, the Peabody Developmental Motor Scales-2 and the Preschool Language Scale, 4th edition. Generalized linear models were used to adjust for factors significantly different between the groups at baseline. Additional analyses were conducted to evaluate the impact of the severity of hydrocephalus. RESULTS In unadjusted comparisons, statistically significant differences were noted between the three groups on the Peabody Gross Motor Quotient and thus the Total Motor Quotient. After adjustment, no statistically significant differences were identified. In subanalyses, children with more severe hydrocephalus fared worse on the Peabody Fine Motor Quotient (median 88 versus 94, p= 0.005), the Total Motor Quotient (median 70 versus 73, p= 0.02) and both Preschool Language Scale subtests (auditory comprehension: median 93 versus 104, p= 0.02 and expressive communication: median 95 versus 104.5, p= 0.01) and thus the total score (median 92 versus 105, p= 0.004). These results remained significant in the multivariable adjusted model. CONCLUSION No neurodevelopmental differences were noted with children enrolled in MOMS across the three hydrocephalus/shunt groups, although severity of hydrocephalus was associated with poorer outcomes.
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Affiliation(s)
- Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela K Burrows
- The George Washington University Biostatistics Center, Rockville, MD, USA
| | - Elizabeth A Thom
- The George Washington University Biostatistics Center, Rockville, MD, USA
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9
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Ivanov SV, Baindurashvili AG, Kenis VM. [Surgical treatment of hip subluxation and luxation in children with spinal hernia consequences]. Khirurgiia (Mosk) 2017:64-68. [PMID: 28805781 DOI: 10.17116/hirurgia2017864-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine surgical tactics for hip subluxation and luxation in children with spinal hernia consequences. MATERIAL AND METHODS The study included 134 patients with hip subluxation and luxation with consequences of cerebrospinal hernias who were examined at the Turner Research Institute for Children's Orthopedics in 2006-2016. The main group consisted of 69 patients who received surgical treatment with hip joint stabilization. The control group included 65 children without surgery. Within each group patients were divided into 2 subgroups depending on level of spinal cord injury by using of Sharrard technique. RESULTS In patients with high lesion (Th and LI-LII) surgical treatment led to impairment of motor function in most cases (71%) (archival material); in case of LIII-LIV and LV-SI segments 25 of 45 (55%) patients improved motor performance while in control group motor function was deteriorated in 13 of 35 (37%) cases. CONCLUSION Neurosegmental level allows to predict the motor function and to determine surgical tactics.
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Affiliation(s)
- S V Ivanov
- Turner Research Institute for Pediatric Orthopedics, Health Ministry of the Russian Federation, St. Petersburg, Russia
| | - A G Baindurashvili
- Turner Research Institute for Pediatric Orthopedics, Health Ministry of the Russian Federation, St. Petersburg, Russia
| | - V M Kenis
- Turner Research Institute for Pediatric Orthopedics, Health Ministry of the Russian Federation, St. Petersburg, Russia
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Ibrahim M, Ismail NJ, Mohammad MA, Ismail H, Ahmed MH, Femi OL, Suwaid MA. Managing fecal incontinence in patients with myelomeningocele in Sub-Saharan Africa: Role of antegrade continence enema (ACE). J Pediatr Surg 2017; 52:554-557. [PMID: 27634558 DOI: 10.1016/j.jpedsurg.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neural tube defects (NTDs) are among the major causes of sphincter dysfunctions. Fecal incontinence (FI) because of myelomeningocele (MMC) leads to problems with social acceptability and decreased quality of life (QOL), life satisfaction in addition to other morbidities. This is a report of experience with antegrade continence enema (ACE) in the management of FI in patients with MMC in an African set-up. MATERIALS AND METHOD A retrospective review of 23 children and young adults with FI because of MMC managed with ACE from October 2008 to September 2015 from African Specialist Hospital. The clinical outcomes have been analyzed. RESULTS From October 2008 to September 2015, a total of thirty-two n=32 patients underwent ACE procedure after repair of MMC associated with FI. Available data of 23 (71.87%) patients were reviewed retrospectively. Mean age at which ACE was created was 6.43±3.83years, range (3.5-17.8) years, median 5years. Follow-up after ACE creation was (0.5-6.9) years, median 2.6years. There were full continence in 13 (56.52%), partial continence in 8 (34.78%) and failure in 2 (8.69%). There were 16 (69.56%) complications and 4 (17.39%) minor post ACE surgery revisions. Mean PedQOL(™) score before ACE and then 5, 10, and 15months after ACE were 47.86±13.83, range (20.4-66.0) vs 88.34±7.11, range (77.9-98.6); p=0.000, 88.9±6.44 range (76.9-98.5); p=0.000, 89.01±6.50, range (76.9-98.88) p=0.000 respectively. Mean parental/caregiver satisfaction score for 15 (65.21%) patients aged 6years and below using modified visual analogue scale (VAS) 1 to 10 before ACE and after were 3.06±0.79, range (2-4), median 3 vs 8.0±1.30, range (5-10), median 8; (p=0.000) while 8 (34.78%) patients aged above 6years were able to assess their satisfactions score before and after ACE creation with mean of 1.75±0.70, range (1-3), median 2 vs 7.75±1.03, range (6-9) median 8; (p=0.000). CONCLUSION ACE has satisfactory outcomes in an African set-up in patients with MMC associated with FI. Multidisciplinary approach to neurogenic FI should be encouraged in such set-ups.
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Affiliation(s)
- Musa Ibrahim
- Children Surgery Unit, Department of Surgery, Murtala Muhammad Specialist Hospital, Kano, Nigeria.
| | - Nasiru Jinjiri Ismail
- Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Hassan Ismail
- Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Kowitzke B, Cohrs G, Leuschner I, Koch A, Synowitz M, Mehdorn HM, Held-Feindt J, Knerlich-Lukoschus F. Cellular Profiles and Molecular Mediators of Lesion Cascades in the Placode in Human Open Spinal Neural Tube Defects. J Neuropathol Exp Neurol 2016; 75:827-42. [PMID: 27354486 DOI: 10.1093/jnen/nlw057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Indexed: 01/07/2023] Open
Abstract
Myelomeningoceles (mmc) are clinically challenging CNS malformations. Although improvement in their management has been achieved with respect to antenatal diagnosis, prevention, and fetal surgery, the cellular mechanisms of damage in the neural placode are poorly understood. We aimed to identify cellular and molecular factors in lesion amplifying cascades in mmc placodes. Seventeen mmc specimens obtained during reconstructive surgery that harbored sufficient neuroepithelial tissue were investigated. Normal adult and stillborn spinal cord tissue served as controls. Placodes exhibited similar cellular profiles with consistent neuronal marker expression, elevated GFAP-/vimentin immunoreactivity in all, and CD3/CD11b/CD68-immunolabeling in some cases. Increased expression of pro-inflammatory (tumor necrosis factor, interleukin-1β [Il-1β]/IL-1 receptor type 1 [IL-R1]) and neuroprotective erythropoietin/erythropoietin receptor (Epo/EpoR) cytokines was detected by immunohistochemistry, double-fluorescence labeling, and real-time RT-PCR. In all cases, there was a multi-cellular induction of IL-1β and IL1-R1. EpoR and Epo immunoreactivity was elevated in some cases with neuronal expression patterns. Epo was further co-expressed with HIF-1/-2α, which paralleled Epo induction in the corresponding placodes. These observations confirm the induction of cellular and molecular alterations in human mmc placodes that resemble the secondary lesion cascades induced by spinal cord injury. The pro-inflammatory and neuroprotective cytokine expression in mmc placodes may represent new targets for the treatment of open neural tube defects.
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Affiliation(s)
- Bea Kowitzke
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Gesa Cohrs
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Ivo Leuschner
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Arend Koch
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Michael Synowitz
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Hubertus Maximilian Mehdorn
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Janka Held-Feindt
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Friederike Knerlich-Lukoschus
- Department of Neurosurgery (BK, GC, MS, HMM, JH-F, FK-L)Department of Pathology (IL), University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany;Department of Neuropathology (AK), Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
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Kural C, Solmaz I, Tehli O, Temiz C, Kutlay M, Daneyemez MK, Izci Y. Evaluation and Management of Lumbosacral Myelomeningoceles in Children. Eurasian J Med 2015; 47:174-8. [PMID: 26644765 DOI: 10.5152/eurasianjmed.2015.138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Myelomeningoceles are the common form of open neural tube defects that are usually associated with neurological deficits. Many techniques of repair and methods of prevention have been proposed with respect to the size of defect and the neurological condition of patient. The aim of this study was to report our experience on the management of lumbosacral myelomeningoceles in children. MATERIALS AND METHODS We retrospectively analysed the data of 36 paediatric cases of surgically lumbosacral myelomeningocele treated in our department between 1998 and 2013. Twenty (56%) patients were female and sixteen were male, with a mean age of 4 months (ranged between 0 and 24 months). All patients had neurological deficits in the preoperative period. Computed tomography was performed in 33 (92%) patients and magnetic resonance imaging in 15 (42%) patients in the preoperative period. Repair of the myelomeningocele and closure of the skin defect were performed in all patients. The mean follow-up period was 36 months. RESULTS Thirty (83%) patients were operated for hydrocephalus and 10 (28%) patients were re-operated for tethered cord syndrome during the follow-up period. Neurological worsening was not observed in any patient while cerebrospinal fluid fistula was detected in 2 patients. CONCLUSION Surgical treatment using appropriate microsurgical techniques is crucial for lumbosacral myelomeningoceles in children. Early surgical intervention with close follow-up will improve the neurological condition of the patients.
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Affiliation(s)
- Cahit Kural
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Ilker Solmaz
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Ozkan Tehli
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Caglar Temiz
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Murat Kutlay
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Mehmet K Daneyemez
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Yusuf Izci
- Clinic of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
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A review of the potential for cardiometabolic dysfunction in youth with spina bifida and the role for physical activity and structured exercise. Int J Pediatr 2012; 2012:541363. [PMID: 22778758 PMCID: PMC3384902 DOI: 10.1155/2012/541363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/05/2012] [Accepted: 04/20/2012] [Indexed: 11/28/2022] Open
Abstract
Children and adolescents who have decreased mobility due to spina bifida may be at increased risk for the components of metabolic syndrome, including abdominal obesity, insulin resistance, and dyslipidemia due to low physical activity. Like their nondisabled peers, adolescents with spina bifida that develop metabolic risk factors early in life have set the stage for adult disease. Exercise interventions can improve metabolic dysfunction in nondisabled youth, but the types of exercise programs that are most effective and the mechanisms involved are not known. This is especially true in adolescents with spina bifida, who have impaired mobility and physical function and with whom there have been few well-controlled studies. This paper highlights the current lack of knowledge about the role of physical activity and the need to develop exercise strategies targeting the reduction of cardiometabolic risk and improving quality of life in youth with spina bifida.
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Haq IZ, Akmal S, Chandler CL, Bassi S. Review of practices in myelomeningocoele repair at King's College Hospital, London. Br J Neurosurg 2012; 26:851-5. [PMID: 22747194 DOI: 10.3109/02688697.2012.697214] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myelomeningocoele remains a significant neurosurgical challenge. We have carried out a retrospective study evaluating the practices of myelomeningocoele repair at our institute over the last 5 years. Additionally, for patients that have been followed up for at least 12 months, we have investigated parameters describing functional outcome up to this period. With the recent Management of Myelomeningocoele (MOMS) study re-igniting interest in the condition, we aim to provide contemporary practice and outcome data to add to the literature.
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Affiliation(s)
- Imran Zahir Haq
- Department of Neurosurgery, King's College Hospital, London, UK.
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