title: Primary repair of open neural tube defect in adulthood: case example and review of management strategies.
abstract: BACKGROUND
  Neural tube defects are congenital malformations that develop when the neural plate fails to close during embryogenesis. The most common open neural tube defect, myelomeningocele (MMC), is declining in frequency in North America. If identified, an MMC must be closed in the perinatal period to prevent lethal complications. Lesions presenting in older adults are, thus, very uncommon.
  
  
  OBJECTIVE
  The purpose of this study was to describe the surgical management of an adult with an unrepaired ulcerated lumbosacral MMC who presented with persistent cerebrospinal fluid (CSF) leakage and to review the management strategies for adult patients with unrepaired MMC.
  
  
  METHODS
  A case report was used for this study.
  
  
  METHODS
  The patient was a 62-year-old woman with an unrepaired ulcerated lumbosacral MMC and associated lower extremity weakness. She sought medical care for persistent lumbar tenderness and ulceration after sustaining a fall 4 months before admission. Physical and radiological assessment revealed a lumbosacral MMC at the L5 and S1 levels and a tethered cord. Surgical resection of the placode and de-tethering were performed.
  
  
  RESULTS
  One week after repair of the lumbosacral MMC, the patient was readmitted for management of continued CSF leakage and hydrocephalus, requiring external ventricular drainage, wound revision, and placement of lumboperitoneal shunt. The patient experienced complete resolution of back pain without additional episodes of CSF leakage.
  
  
  CONCLUSIONS
  This rare case and review of management strategies suggests that proper surgical management of open MMC in adulthood can successfully be performed and improve patient symptoms and prevent further complications.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, USA.
authors.forename: Jakub
authors.initials: J
authors.lastname: Godzik
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt, Lake City, UT 84132, USA.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Washington University in St. Louis, 660 S. Euclid, Box 8057, St. Louis, MO 63110, USA.
authors.forename: Wilson Z
authors.initials: WZ
authors.lastname: Ray
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 301, MSC 606, Charleston, SC 29425-6160, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Eskandari
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt, Lake City, UT 84132, USA. Electronic address: Andrew.Dailey@hsc.utah.edu.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery; D008591:Meningomyelocele / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects
keywords: Cerebrospinal fluid; Hydrocephalus; Lumboperitoneal shunt; Myelomeningocele; Spinal dysraphism; Tethered cord