Early closure of myelomeningocele, with special reference to leg movement.

Open Myelomeningocele-Mawdsley et al. MEDUBARL1TURNrm compared with those of a series of unoperated children reported from South Wales. Myelomeningocele is a relatively common anomaly, the surgical attitude to which has changed over the past few years to a more active approach. This has been encouraged by advances in the general management of paraplegia and its complications and the more successful surgery of hydrocephalus. The extensive surveys by Laurence (1964) of the natural history of spina bifida have established that many infants with this defect die within the first six months of life, but that there is an appreciable natural survival rate thereafter. He also showed that there was an increased chance of survival into later life of children whose myelomeningocele had been treated surgically compared with similar but untreated patients, though these observations reflect the kind of selective surgery which was practised a decade ago. Doran and Guthkelch (1961) reported a 70% survival rate in a large group of patients selected for surgery between the third and twelfth months of life, whereas those rejected for surgery (over 40% of the total) showed only a 7.5% survival rate. In considering the question of when to repair the spinal defect, Guthkelch (1962a) initially reported very poor results from operating on a small series within the first 24 hours of life, but more recently he reported a series of cases closed within 24 hours of birth with a 19% mortality (Guthkelch, 1965). A great stimulus was added to the early closure of these lesions when Sharrard, Zachary, Lorber, and Bruce (1963) published the results of a controlled trial of immediate closure and non-operative management. The mortality of both groups was high, but in the operated group muscle function had improved in some of the survivors, whereas it had deteriorated in some who had survived on conservative management (Sharrard et al., 1963). In 1963 it was decided to study a consecutive series of 25 infants with myelomeningocele closed within the first 24 hours of birth; to investigate the reasons for the high mortality of this kind of surgery so far reported ; to ascertain the significance of stimulation of the involved neural tissue at the time of operation ; and to see whether the suggestion that early closure promotes improvement in muscle function of the legs could be confirmed. infants with open myelomeningocele were referred from the East Anglian Region to the department of …