title: Myelomeningocele - a single institute analysis of the years 2007 to 2015.
abstract: BACKGROUND
  After the introduction of folate supplementation, the number of open spinal dysraphism was successfully reduced over time. In 2007, the department for pediatric neurosurgery was established in the children's hospital. Since then, newborns with myelomeningocele (MMC), the most common form of open neural tube defects (NTD), are treated here. The aim of this study is to present the concepts applied to and experiences resulting from treatment of MMC.
  
  
  METHODS
  Records of all newborns with MMC treated surgically during the period January 2007 to August 2015 in our institution were analyzed. Children, who were previously operated in utero were excluded. The type of neural tube defect, its location, associated comorbidities, and ambulation were recorded.
  
  
  RESULTS
  Forty-eight children (25 males, 23 females) with spinal dysraphism were included in the analysis. In nearly 90 % of the cases, the repair of the MMC was done on the day of delivery. The follow-up period ranges from 9 weeks to 8 9/12 years (loss of follow-up in 2 cases). In 19 %, the defect remained undetected during gestation and in one case, carbamazepine was taken despite pregnancy. In 36 children (75 %), we found a Chiari malformation type II (CMII) associated with myelomeningocele. 85.4 % suffered from hydrocephalus and implantation of a shunt was necessary. In cases of bladder impairment, an intermittent catheterization was the most common management (83.3 %); no bladder augmentation was required. Twelve children required orthopedic surgery. Twenty-three of 33 patients (70 %) are ambulatory w/wo orthoses and devices. The 13 children who are younger than 2 years were considered separately to assess the motor activity safely.
  
  
  CONCLUSIONS
  Our data show that neural tube defects to this day can remain undetected despite medical care during pregnancy. The most common associated diseases with MMC are Chiari II malformations and hydrocephalus. In the seven cases of simultaneous repair of MMC with shunt implantation, no additional complications were encountered. An interdisciplinary approach was allowed in a high percentage independence and social continence.
authors.affiliation: Neurosurgical Department, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach, Germany. e.januschek@gmx.de.|Neurosurgical Department, Asklepios Children's Hospital, Arnold-Janssen Straße 29, 53757, Sankt Augustin, Germany. e.januschek@gmx.de.
authors.forename: Elke
authors.initials: E
authors.lastname: Januschek
authors.affiliation: Neurosurgical Department, Asklepios Children's Hospital, Arnold-Janssen Straße 29, 53757, Sankt Augustin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Röhrig
authors.affiliation: Neurosurgical Department, Asklepios Children's Hospital, Arnold-Janssen Straße 29, 53757, Sankt Augustin, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kunze
authors.affiliation: Department of Neonatology and Pediatric Intensive Care Medicine, Asklepios Children's Hospital, Arnold-Janssen Straße 29, 53757, Sankt Augustin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fremerey
authors.affiliation: Department of Neonatology and Pediatric Intensive Care Medicine, Asklepios Children's Hospital, Arnold-Janssen Straße 29, 53757, Sankt Augustin, Germany.
authors.forename: Bea
authors.initials: B
authors.lastname: Wiebe
authors.affiliation: Neurosurgical Department, Asklepios Children's Hospital, Arnold-Janssen Straße 29, 53757, Sankt Augustin, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Messing-Jünger
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies
keywords: Chiari malformation; Hydrocephalus; Neural tube defect; Spinal dysraphism