1/37. The split notochord syndrome with dorsal enteric fistula, meningomyelocele and imperforate anus.A male infant was referred to our department because of lumbosacral meningomyelocele, dorsal enteric fistula and imperforate anus. The mother had received a parenteral drug containing estradiol benzoate and progesterone for inducing abortion in the first trimester. She also used an anal pomade containing triamcinolone and lidocaine-HCl during the pregnancy for hemorrhoids. Sigmoid end colostomy was performed after meningomyelocele repair. On abdominal exploration a wandering spleen was detected but no other anomalies. Two months later, an abdominoperineal pullthrough was performed, and the patient was discharged well after three weeks. Our case is the sixth that had split notochord syndrome associated with dorsal enteric fistula and imperforate anus. Additionally, penoscrotal transposition and wandering spleen were present in this case. To our knowledge, these associated anomalies have been extremely rare.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/37. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.STUDY DESIGN: A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. OBJECTIVES: To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment. SUMMARY OF BACKGROUND DATA: No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients. methods: After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal. RESULTS: Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative staphylococcus, enterobacter, enterococcus, and escherichia coli.- debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012). CONCLUSIONS: patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. patients in whom infection develops are then at increased risk for pseudarthrosis.- - - - - - - - - - ranking = 5215.2003724667keywords = closure (Clic here for more details about this article) |
3/37. Benign symmetric lipomatosis with myelomeningocele in an adolescent: An uncommon association-case report.The authors report an unusual localization of symmetric adipose tumors associated with spinal dysraphism. Initially, the patient underwent a closure of the lumbosacral myelomeningocele. At that time, the tumors were not evident and remained undiscovered up until puberty. However, during puberty, the symmetric lipomatous masses grew at the perineal region. Except the patient's age, all findings and the clinical picture supported the diagnosis of a benign symmetric lipomatosis (BSL). To the authors' knowledge, the following case has not been described previously.- - - - - - - - - - ranking = 1043.0400744933keywords = closure (Clic here for more details about this article) |
4/37. Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects.Closure of large meningomyelocele wounds and defects always requires durable and safe coverage of the dural repair. A new technical method for the reconstruction of large thoracolumbar meningomyelocele defects is described in which bilateral musculocutaneous flaps are advanced and transposed medially in a V-Y sliding manner, based on the thoracolumbar perforatiors of the latissimus dorsi. This procedure provides a reliable, well-vascularized soft tissue coverage over the neural repair with minimum donor-site morbidity. Additionally, this method is particularly appropriate to the thoracolumbar area, as it preserves the lateral adjacent regions of the defect, for later alternative and/or reconstructive options.- - - - - - - - - - ranking = 4172.1602979734keywords = closure (Clic here for more details about this article) |
5/37. Double myelomeningocele: case report and review.The presence of a myelomeningocele at multiple levels along the spinal column is a rare event. There are only a few cases of double myelomeningocele reported in the world's literature. Large myelomeningoceles present surgical closure challenges due to the size and location of these defects. We report the case of a newborn female who had two myelomeningoceles with one at the thoracic level and the other at the lumbar level. Surgical closure must provide durable and stable coverage for the spinal cord. Stable coverage was provided for this patient using bilateral paraspinous myofascial turnover flaps. This unusual case report as well as a review of the literature is presented.- - - - - - - - - - ranking = 2086.0801489867keywords = closure (Clic here for more details about this article) |
6/37. Using the sac membrane to close the flap donor site in large meningomyeloceles.If a large transposition flap with or without muscle is used for closure of a large meningomyelocele defect, then, a part of the donor site of the flap can be closed by split thickness skin graft, which produces an additional donor wound for the patient. We used the sac membrane instead of split thickness skin graft for closure of donor sites of fasciocutaneous flaps and latissimus dorsi musculocutaneous flaps employed to cover large meningomyelocele defects. This technique was used in three thoracolumbar and in two lumbosacral meningomyelocele patients. The sac membrane was prepared like a full thickness skin graft. Follow-up in five patients has ranged from 1 to 18 months, with a mean of 10.6 months. The donor sites that were closed by the sac membrane exhibited complete healing in all patients. We conclude that the sac membrane supplies a reserve of epithelialised tissue that can be used for repair of the meningomyelocele defects.- - - - - - - - - - ranking = 2086.0801489867keywords = closure (Clic here for more details about this article) |
7/37. Neurosurgical reconstruction with acellular cadaveric dermal matrix.Acellular cadaveric dermal matrix (ACDM) is processed from human cadaver skin (AlloDerm; life Cell Corp., Branchburg, NJ). It does not require an immediate blood supply but can transmit essential interstitial fluids for nourishment of overlying tissues. A number of neurosurgical reconstructions have required the use of tissue that fills these specifications. The material has been used most recently for reconstruction of dura during craniotomies when primary closure is not possible or harvesting from an autologous site is not available. Because ACDM is harvested from nonneurologic cadaveric tissues and because the cellular and antigenic elements have been removed from the matrix, prion diseases are not a transmission risk. We present 6 examples of previously unreported uses of ACDM for successful repair of meningomyelocele, cauda equina, encephalocele, cerebrospinal fluid fistula, and neuroma. We propose the use of ACDM as a valuable tool in neurosurgical reconstruction.- - - - - - - - - - ranking = 1043.0400744933keywords = closure (Clic here for more details about this article) |
8/37. Lumbar myofascial flap for pseudomeningocele repair.OBJECT: Initial management for lumbar pseudomeningoceles entails the closed external drainage of cerebrospinal fluid (CSF) with or without blood patch application. The presence of longstanding pseudomeningoceles and those associated with nonmicroscopic dural tears can be more problematic. Additionally the failure of nonoperative measures may necessitate surgery. Ideally the procedure should involve repairing the dural defect, removing the encapsulated cavity of the pseudomeningocele, and obliterating the extraspinal dead space to minimize the recurrence of the problem. methods: The authors describe a technique performed in 12 patients with large (> 5-cm-diameter) pseudomeningoceles referred for management following the failure of less aggressive measures. diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. They were treated between July 1990 and July 1998. The cause of the pseudomeningoceles was lumbar discectomy (four patients), lumbar decompression (one patient), lumbar decompression and placement of instrumentation (five patients), and intradural procedures (two patients). Their mean age was 47.9 years (range 20-67 years), and they presented at a mean of 5.5 months postoperatively (range 3 weeks-37 months). In all cases there was a satisfactory repair of the pseudomeningocele, dead space obliteration, and long-term symptomatic resolution. CONCLUSIONS: Lumbar myofascial advancement for this problem is a useful technique in cases of symptomatic pseudomeningoceles. This technique requires the medial advancement of the musculofascial units of the paravertebral muscles for a layered closure over the exposed spinal canal with obliteration of the pseudomeningocele.- - - - - - - - - - ranking = 1043.0400744933keywords = closure (Clic here for more details about this article) |
9/37. Triple neural tube defect--cranium bifidum with rostral and caudal spina bifida--live evidence of multi-site closure of the neural tube in humans.OBJECTIVE: The coexistence of three neural tube defects (NTDs) in a single child is an exceptional event. A review of the literature revealed nine published "double" NTD cases, but no cases of "triple" NTDs have been reported to date. CASE REPORT: The rare case of a two-year-old boy with three distinct NTDs is presented. The boy had a 17x15x15-cm(3) parieto-occipital encephalocele, a small cervical myelomeningocele, and a 11x11x8-cm(3) thoracolumbar myelomeningocele. hydrocephalus and Chiari II malformation accompanied the NTDs. All three lesions were surgically treated with good cosmetic results and satisfactory neurologic outcome. CONCLUSIONS: Current neural tube closure theories and models are reviewed in an attempt to better understand this extremely unusual coexistence. The multi-site closure model is clearly more useful in our understanding of NTDs.- - - - - - - - - - ranking = 6258.24044696keywords = closure (Clic here for more details about this article) |
10/37. Spinal rhabdomyosarcoma in a child with lipomyelomeningocele.Malignant tumors arising within dysrhaphic malformations are very rare and are mostly teratomas; so far, only one rhabdomyosarcoma has been reported in this context. We report another case of a girl with lipomyelomeningocele who developed a lumbar rhabdomyosarcoma 2 years after birth and primary closure of the neural tube defect. We present clinical, radiological and pathological findings, discuss possible mechanisms of malignant transformation and review the literature.- - - - - - - - - - ranking = 1043.0400744933keywords = closure (Clic here for more details about this article) |
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