Meningomyelocele Repair: A Surgical Audit and Outcome Analysis

A BSTRACT Background: Myelomeningocele (MMC) is the protrusion of the meninges and spinal cord through a defect in the vertebral arches. For successful and long-term outcomes, timely intervention and a multidisciplinary approach are of utmost importance. Objective: Describe the surgical outcomes of MMC and the impact of different factors on long-term prognosis. Methods: We conducted the study using hospital records of 29 patients (below the age of 12 years) who underwent surgical management for lumbosacral MMC over the last five years. Data regarding patients’ demographics, presenting symptoms, findings of neuroimaging, operative records, and outcomes were cumulated and analyzed. Results: Here, the median age of patients was four months, with a male–female ratio of 1.9:1. Five patients had ruptured MMC. Fifteen patients had abnormal findings in the neuroimaging study. Cerebrospinal fluid (CSF) leakage was observed in three patients, and a significant association ( P < 0.001) was found between the CSF leak and the closure technique. A ventriculoperitoneal shunt was needed in 14 patients, of whom six underwent shunt surgery in the same setting during MMC repair. There was no postoperative mortality; however, seven had wound-related complications, three developed urinary incontinence, and one developed a shunt block requiring repositioning. Conclusions: The MMC repair technique influences the postoperative CSF leak; however, it does not affect the long-term prognosis. Age at operation and abnormal findings in the neuroimaging do not influence the surgical outcome in terms of wound infection, CSF leak, bowel-bladder problems, or the requirement of future shunt surgery.