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  • Outcome of Surgical Management of Patients with Split Cord Malformation Associated with Myelomeningocele

    Final Number:
    456

    Authors:
    Ahmed Mohamed Elsawaf MD PhD; Amgad El-said Matter MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: It is now obvious that Split cord malformation (SCM) is not merely an entity of occult dysraphism; it may coexist with open spinal dysraphism, like myelomeningocele (composite or complex spina bifida) in significant number of cases. It is surprising that about 40.8% cases of all SCM present with myelomeningocele, suggesting that open and closed form of spinal dysraphism may coexist. The goal of our study is to assess the outcome of surgical management of split cord malformations associated with myelomeningocele and to describe the tethering factors detected during surgery with surgical removal of those factors, then assessment of the patients clinically after surgery and follow- up of re-tethering cases

    Methods: A total of 14 patients treated at Suez Canal University were found to have both SCM and MMC in the period between 2004 and 2008. They were operated for both pathologies simultaneously. They were followed by clinical examination, and had a radiological assessment by thin cuts CT scans and MRI studies

    Results: We observed high incidence of split cord malformations occurred in patients with open spina bifida (12%). Statistically significant improvement of surgical outcome was observed in our study. After a mean of 18 months follow-up: None of the patients had shown worsening of the motor power or sphincter control. All the patients with preoperative motor deficit had significant improvement of the deficit. Eleven patients with preoperative severe motor power deficit (grade 0-1) have shown significant improvement of the motor power (P=0.023), with movement against gravity or higher grade in all joints. There was No evidence of re-tethering at the final follow-up period. Using fibrin glue with water-tight closure of the dura decreased CSF leak significantly

    Conclusions: Early surgical management of combined split cord malformation with myelomeningocele (complex spina bifida) provide a good results if managed adequately with removal of all tethering factors

    Patient Care: better identification of causes of tethering and their management

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the most common causes of cord tethering in this group of patients, 2) Discuss, in small groups,how to untether cord in complex spina bifida

    References:

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