Results of early treatment of meningomyelocele

Aim: Comparison between the results of early and late surgical treatment of myelomeningocele. The early surgical treatment was provided in 1998 - June 2008 in the first 24 hours after birth. The late surgical treatment was provided later than 24 hours after birth. Material and methods: We evaluated a pre- and postoperative condition of 22 patients who went under operations in 1998 - June 2008 in the University Children’s Hospital in Cracow because of dysraphia with coexisting myelomeningocele. The second group involved 305 children who went under operations in 1973 -1997 because of the same reason. The operative time varied from one to over 2 days. A retrospective evaluation was carried on of the histories of patients’ data. Results: We evaluated the time of hospitalization, a number of postoperative complications and the operative mortality. We evaluated the number of meningitis in particular and the operative time of hydrocephalus. The operative mortality in 1969- 1973 was 53%, in 1974- 1997 was 16% and in 1998- 2008 was 2,5%. In 4 cases the implantations of ventriculo- peritoneal shunts, because of the hydrocephalus, were followed by the operations for myelomenigocele.. In 1998- June 2008 the homogenous operative treatment was provided. In order to close the posterior wall of spinal canal we used only the autologic tissues and a collagen fleece coated with fibrin glue. There was no use of artificial insoluble materials. The skin rotation flaps were taken from well innervated regions. Conclusions: Early homogenous treatment ( first 24 hours after birth) of myelomeningocele highly improves the postoperative recovery because the number of postoperative inflammatory complications decreases.