Correlation of Neurological Deficits in Patients with Myelomeningocele on the Basis of Anatomical Location and Size of Base of Defect

Aims and Objectives: To analyze data regarding relationship of myelomeningocele at different anatomical locations along vertebral canal and size of base defect. Study Design: Descriptive analytic study. Setting: Department of pediatric surgery, King Edward Medical University / Mayo Hospital Lahore. Duration of the study: 2 years from October 2017 to September 2018. Methodology: During study period a total of 60 patients (n=60) with myelomeningocele at different anatomical locations along the vertebral column were admitted. Inclusion criteria was: • All patients under 3 months of age with myelomeningocele. • Patients with intact myelomeningocele membrane. • None infected cases. A detailed research performa was made having all variables and data was collected regarding total number of patients, gender, location of myelomeningocele along vertebral canal, presence or absence of neural tissue in sac, size of base of defect, associated neurological deficits, treatment and outcome were noted and statistical analysis was done by using SPSS version 24. Results: A total of 60 patients with myelomeningocele meeting the inclusion criteria were admitted. Most common age of presentation was 1 to 2 month 26 (43.3 %). There were 43 (71.6%) males and 17 (28.3%) female patients. Regarding anatomical locations of myelomeningocele along vertebral canal, there were 4 (6.6 %) cases of cervical, 2 (3.3 %) cases with thoracic, 5 (8.3%) cases with thoracolumber, 38 (63.3%) cases with lumbosacral and 11 (18.3%) cases with sacral myelomeningocel. No neural tissue was found in cervical and thoracic myelomeningocele, but was found in 3 (60%) cases of thoracic lumber myelomeningocele, in 37 (97%) cases of lumbosacral myelomeningocele, in 11 (100%) cases of sacral myelomeningocele. No neurological deficit was found in cervical, thoracic and thoraco lumber myelomeningocele. Paralysis of lower limbs was found in 8 (13.3%) cases of lumbosacral myelomeningocele and in 2 (3.3%) cases of sacral myelomeningocele. Paresis of lower limbs was found in 7 (11.6%) cases of lumbosacral myelomeningocele and in 2 (3.3%) cases of sacral myelomeningocele. Fecal incontinence as found in 12 (20%) cases of lumbosacral myelomeningocele and in 4 (6.6%) cases of sacral myelomeningocele. Urinary incontinence was found in 12 (20%) cases of lumbosacral myelomeningocele and in 4 (6.6%) cases of sacral myelomeningocele. In most of cases wound closure was done by simple skin closure, in 12 (20%) cases defect was closed by raising Sshaped rotational flap. Wound infection was noted in 4 (6.6%) cases while there was complete wound dehiscence in 3 (5%) cases. In 2 (3.3%) cases there was post operative leakage of CSF from wound and post operative ventriculitis was observed in 01 (1.6%) case. Hydrocephalus observed in 16 (26.6%) cases of myelomeningocele was treated with ventriculo _ peritoneal shunting. Conclusion: Myelomeningocele is very serious congenital anomaly leading to future disability in children. It can be prevented by prescribing folic acid in pregnancy. A detailed neurological evaluation of patient before and after surgery is important in planning for surgery and rehabilitation.