Neurosurgical management of occult spinal dysraphism associated with OEIS complex.
BACKGROUND
OEIS complex has been described as a combination of defects consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal defects (S). As the first three defects are life-threatening and treated on a priority basis, neurosurgical intervention for spinal defects is deferred until recuperation from abdominogenital repair. However, the best timing for neurosurgical operation has not been precisely described.


METHODS
We reviewed our neurosurgical management of three cases (case 1: myelomeningocele; cases 2 and 3: terminal myelocystocele). At 2-6 (3.6 on average) months after birth, neurosurgical procedures, including reduction of the size of the lumbosacral cystic lesion and untethering of the spinal cord, were performed.


RESULTS
During this period, the patients' weights increased from 1,911 to 3,368 g on average, and the lumbosacral cystic lesion was markedly enlarged. In all cases, no neurological deterioration was seen, and ventriculoperitoneal shunt was not indicated.


CONCLUSIONS
Thus, neurosurgical procedures can be performed in patients weighing 3-4 kg and/or at an age of 3 months, after confirming recuperated conditions from abdominogenital repair. Careful observation should be made of the size of the lumbosacral cystic lesion and neurological deterioration.
Morioka
Takato
T
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. takato@ns.med.kyushu-u.ac.jp
Hashiguchi
Kimiaki
K
Yoshida
Fumiaki
F
Matsumoto
Kenichi
K
Miyagi
Yasushi
Y
Nagata
Shinji
S
Yoshiura
Takashi
T
Masumoto
Kouji
K
Taguchi
Tomoaki
T
Sasaki
Tomio
T
D001006:Anus, Imperforate / Q000150:complications / Q000601:surgery*; D002648:Child; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications / Q000601:surgery*