Meconium staining of the brainstem with open myelomeningocele

Case report

Sandi Lam M.D., M.B.A. 1 , Ramesh Grandhi M.D. 2 , and Stephanie Greene M.D. 3
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  • 1 Department of Surgery, Section of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois;
  • 2 Department of Neurosurgery, University of Pittsburgh; and
  • 3 Department of Neurosurgery, University of Pittsburgh, Children's Hospital of Pittsburgh, Pennsylvania
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Meconium staining of open myelomeningoceles has been reported to occur both prenatally and postnatally, but meconium staining of the brainstem has not been previously documented. The authors present a case of meconium staining of the brainstem in an infant with a meconium-stained myelomeningocele, Chiari malformation Type II, and hydrocephalus and discuss possible implications for prenatal and perinatal care.

Abbreviation used in this paper:CM-II = Chiari malformation Type II.

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Contributor Notes

Address correspondence to: Sandi Lam, M.D., M.B.A., Department of Surgery, Section of Neurosurgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 3026, Room J341, Chicago, Illinois 60637. email: slam@surgery.bsd.uchicago.edu.

Please include this information when citing this paper: published online November 16, 2012; DOI: 10.3171/2012.10.PEDS1293.

  • 1

    Adzick NS, , Thom EA, , Spong CY, , Brock JW III, , Burrows PK, & Johnson MP, : A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:9931004, 2011

    • Search Google Scholar
    • Export Citation
  • 2

    Agamanolis DP, , Hite SH, , Platt MS, & Boeckman CR: Arnold-Chiari malformation. Report of four cases with contamination of the central nervous system by amniotic contents. Surg Neurol 25:261266, 1986

    • Search Google Scholar
    • Export Citation
  • 3

    Akgür FM, & Olguner M: Amniotic fluid exchange vs amniofusion in gastroschisis. Surg Endosc 17:20322034, 2003. (Letter)

  • 4

    Api A, , Olguner M, , Hakgüder G, , Ateş O, , Ozer E, & Akgür FM: Intestinal damage in gastroschisis correlates with the concentration of intraamniotic meconium. J Pediatr Surg 36:18111815, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Bell WO, , Charney EB, , Bruce DA, , Sutton LN, & Schut L: Symptomatic Arnold-Chiari malformation: review of experience with 22 cases. J Neurosurg 66:812816, 1987

    • Search Google Scholar
    • Export Citation
  • 6

    Cayabyab RG, , Kwong K, , Jones C, , Minoo P, & Durand M: Lung inflammation and pulmonary function in infants with meconium aspiration syndrome. Pediatr Pulmonol 42:898905, 2007

    • Search Google Scholar
    • Export Citation
  • 7

    Cochrane DD, , Adderley R, , White CP, , Norman M, & Steinbok P: Apnea in patients with myelomeningocele. Pediatr Neurosurg 16:232239, 1991

  • 8

    Correia-Pinto J, , Reis JL, , Hutchins GM, , Baptista MJ, , Estevão-Costa J, & Flake AW, : In utero meconium exposure increases spinal cord necrosis in a rat model of myelomeningocele. J Pediatr Surg 37:488492, 2002

    • Search Google Scholar
    • Export Citation
  • 9

    Danzer E, , Ernst LM, , Rintoul NE, , Johnson MP, , Adzick NS, & Flake AW: In utero meconium passage in fetuses and newborns with myelomeningocele. Clinical article. J Neurosurg Pediatr 3:141146, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Drewek MJ, , Bruner JP, , Whetsell WO, & Tulipan N: Quantitative analysis of the toxicity of human amniotic fluid to cultured rat spinal cord. Pediatr Neurosurg 27:190193, 1997

    • Search Google Scholar
    • Export Citation
  • 11

    Haines SJ, & Berger M: Current treatment of Chiari malformations types I and II: a survey of the Pediatric Section of the American Association of Neurological Surgeons. Neurosurgery 28:353357, 1991

    • Search Google Scholar
    • Export Citation
  • 12

    Heffez DS, , Aryanpur J, , Hutchins GM, & Freeman JM: The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury. Neurosurgery 26:987992, 1990

    • Search Google Scholar
    • Export Citation
  • 13

    Holschneider AM, , Bliesener JA, & Abel M: [Brain stem dysfunction in Arnold-Chiari II syndrome.]. Z Kinderchir 45:6771, 1990. (Ger)

  • 14

    Hutchins GM, , Meuli M, , Meuli-Simmen C, , Jordan MA, , Heffez DS, & Blakemore KJ: Acquired spinal cord injury in human fetuses with myelomeningocele. Pediatr Pathol Lab Med 16:701712, 1996

    • Search Google Scholar
    • Export Citation
  • 15

    Meuli M, , Meuli-Simmen C, , Hutchins GM, , Seller MJ, , Harrison MR, & Adzick NS: The spinal cord lesion in human fetuses with myelomeningocele: implications for fetal surgery. J Pediatr Surg 32:448452, 1997

    • Search Google Scholar
    • Export Citation
  • 16

    Muller F, , Oury JF, , Dumez Y, , Boué J, & Boué A: Microvillar enzyme assays in amniotic fluid and fetal tissues at different stages of development. Prenat Diagn 8:189198, 1988

    • Search Google Scholar
    • Export Citation
  • 17

    Olguner M, , Akgür FM, , Ozdemir T, , Aktuğ T, & Ozer E: Amniotic fluid exchange for the prevention of neural tissue damage in myelomeningocele: an alternative minimally invasive method to open in utero surgery. Pediatr Neurosurg 33:252256, 2000

    • Search Google Scholar
    • Export Citation
  • 18

    Pollack IF, , Pang D, , Albright AL, & Krieger D: Outcome following hindbrain decompression of symptomatic Chiari malformations in children previously treated with myelomeningocele closure and shunts. J Neurosurg 77:881888, 1992

    • Search Google Scholar
    • Export Citation
  • 19

    Pollack IF, , Pang D, , Kocoshis S, & Putnam P: Neurogenic dysphagia resulting from Chiari malformations. Neurosurgery 30:709719, 1992

  • 20

    Stritzke AI, , Dunham CP, , Smyth JA, & Steinbok P: Congenital stridor in the context of Chiari malformation type II: the etiological role of vernix caseosa granulomatous meningitis. Case report. J Neurosurg Pediatr 8:372376, 2011

    • Search Google Scholar
    • Export Citation
  • 21

    Talabani H, , Dreux S, , Luton D, , Simon-Bouy B, , Le Fiblec B, & Col JY, : Fetal anal incontinence evaluated by amniotic fluid digestive enzyme assay in myelomeningocele spina bifida. Pediatr Res 58:766770, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Tubbs RS, & Oakes WJ: Treatment and management of the Chiari II malformation: an evidence-based review of the literature. Childs Nerv Syst 20:375381, 2004

    • Search Google Scholar
    • Export Citation
  • 23

    Vandertop WP, , Asai A, , Hoffman HJ, , Drake JM, , Humphreys RP, & Rutka JT, : Surgical decompression for symptomatic Chiari II malformation in neonates with myelomeningocele. J Neurosurg 77:541544, 1992

    • Search Google Scholar
    • Export Citation
  • 24

    Walsh DS, , Adzick NS, , Sutton LN, & Johnson MP: The Rationale for in utero repair of myelomeningocele. Fetal Diagn Ther 16:312322, 2001

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