Operative repair of lumbosacral myelomeningocele

Technical note

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✓ A technique is described for closure of lumbosacral myelomeningoceles. The pathological anatomy of these lesions is examined, and the junction of the skin and dura is identified as the “junctional zone.” This zone permits maximal preservation of the available dura for watertight closure after operative dissection. The junctional zone also serves as an anchor for traction sutures, permitting skin closure without tension. Seventy consecutive repairs have been completed by the authors without significant complications. There have been no instances of cerebrospinal fluid leaks, meningitis, or wound dehiscence. In all cases the repair was carried out rapidly and in a single stage.

Article Information

Address reprint requests to: John P. Laurent, M.D., Texas Children's Hospital, Suite O-202, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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Figures

  • View in gallery

    Gross view (A), and gross (B) and cross-sectional (C) anatomical schemata with identification of incisions.

  • View in gallery

    Gross view (A), and gross (B) and cross-sectional (C) anatomical schemata illustrating the neural plaque after entering the sac and removal of the membranous portion lying in the dural lined cavity, and separation of the junctional zone from the lumbodorsal fascia. Arrows indicate direction of incision.

  • View in gallery

    Gross view (A), and gross (B) and cross-sectional (C) anatomical schemata illustrating the location of the junctional zone and closure of the dura.

  • View in gallery

    Gross view (A), and gross (B) and cross-sectional (C) anatomical schemata illustrating approximation of skin at the junctional zone.

  • View in gallery

    Gross (A) and cross-sectional (B) anatomical schemata illustrating final closure of the myelomeningocele.

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