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Lawrence C. Dempsey and Byron C. Pevehouse

L ymphatic fistula is an unreported complication of myelomeningocele repair. Its occurrence following radical neck dissection, bowel resection, extremity surgery, node biopsy, node dissection, and thoracotomy is well known. 4, 9 Nonsurgically induced lymphatic fistulae can be caused by carcinoma 4 and radiation therapy. 5 This report documents the entity and describes its successful management. Case Report A 3-year-old girl was referred to the University of California Hospital in San Francisco on June 6, 1973, for repair of a large thoracolumbar

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Kunihiko Osaka, Takashi Tanimura, Akihiko Hirayama, and Satoshi Matsumoto

M yelomeningocele after birth has been studied extensively and its features have been well documented. The state of myelomeningocele before birth is still poorly understood, because the opportunity to study such malformed embryos or fetuses is very limited. Only about 40 specimens (including anencephalic specimens) have been reported in the literature. 15 Most reports contain one or two, or several at the most, embryos or fetuses with the malformation, while over 1000 infants with spina bifida cystica were collected and analyzed in one clinic. 29 Since the

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William R. Cheek, John P. Laurent, and David A. Cech

T he goal of surgery in myelomeningocele closure is to preserve neurological function and prevent infection. Although early surgery has not been shown to improve neurological status, it can significantly decrease the risk of death or disability related to infections. 3, 7, 12 Surgery is carried out as early in life as is medically feasible. Neonatal surgery carries special risks, particularly with regard to hypothermia and hypovolemia. Any planned procedure must be rapid, able to be performed with minimal blood loss, and be adaptable to anatomical features

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Robert N. Mitgang

A lthough the existence of presacral and coccygeal teratomas has been appreciated for some time, and although several reports of intraspinal teratomas have appeared sporadically, 4, 9, 12, 13, 22 the occurrence of such a tumor attached to a root of the cauda equina within a myelomeningocele is rare. 2, 7, 15, 16 Case Report This male infant was delivered by Caesarean section and transferred to the Children's Hospital Medical Center of Northern California on July 2, 1970, at the age of 3 days, because of a very large head and a lumbar myelomeningocele. A

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Nalin Gupta, Jody A. Farrell, Larry Rand, Charles B. Cauldwell, and Diana Farmer

edition. References 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 : 993 – 1004 , 2011 2 Bruner JP , Tulipan N , Paschall RL , Boehm FH , Walsh WF , Silva SR , : Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus . JAMA 282 : 1819 – 1825 , 1999 3 Copp AJ , Greene ND , Murdoch JN : The genetic basis of mammalian neurulation . Nat Rev Genet 4

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Zohreh Habibi, Farideh Nejat, Parisa Emami Naeini, and Fatemeh Mahjoub

dorsal midline mass in an infant may suggest a variety of diagnoses, including different types of NTDs such as MMCs, meningoceles, and lipomyelomeningoceles, as well as some less prevalent diagnoses such as teratomas, hamartomas, or even a human tail. 1 , 17 , 23 , 25 Myelomeningocele is not uncommon among patients harboring a dorsal midline mass. 14 On the other hand, a teratoma presenting as a dorsal mass has been shown to be very rare, accounting for only 3 to 9% of all intraspinal tumors in childhood. 5 , 17 , 21 The association of these two conditions in a

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A. Leland Albright and Humphrey Okechi

P ublications about myelomeningocele (MMC) closure techniques generally recommend preservation of the neural placode as well as nerves entering and exiting the placode, because of the postulate that the placode has neurological function. 3 , 4 , 10 , 12 Myelomeningoceles in infants have rarely been treated with cordectomies, in which the distal spinal cord is divided proximal to the placode and the placode and its exiting nerves are resected, although cordectomies have been done in paraplegic children with recurrent MMC tethering, syringomyelia, and

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Ricardo H. Brau, Rafael Rodríguez, Mayra Vera Ramírez, Rosario González, and Virginia Martínez

M anagement of the newborn with myelomeningocele has stirred great controversy, 1, 3, 4, 6, 9–12, 14, 15, 20, 23–25, 27–29, 35, 39, 40 the most critical issue being the identification of which patients will benefit from treatment. This controversy involves medical, legal, ethical, moral, economic, social, and humanitarian issues. Our policy has been to operate in all cases. Having adopted this policy, we could concentrate on dealing with the neurosurgical problems of these children. Some of the questions that arise are: what is the optimal timing for

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Robert F. Heimburger

I n 1950, a program for repairing myelomeningoceles as soon as possible after birth was initiated at the James Whitcomb Riley Hospital for Children. It was reasoned that early closure of the skin defect would decrease infections and increase survival. This decision was reinforced by the Chambers report 1 of improved function and survival of a small number of babies operated on soon after birth. This study is concerned with the optimal time to repair myelomeningoceles. Patient Population All patients (104) referred to the hospital with myelomeningocele

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Sophie Foss, Tracy M. Flanders, Gregory G. Heuer, and Jane E. Schreiber

S pina bifida is a congenital malformation in which the neural tube fails to develop and close properly, resulting in a defect in early neurulation. 17 Open spina bifida, or myelomeningocele (MMC), is the most common and severe form of spina bifida. Due to altered neurodevelopment, individuals with MMC often have multiple central nervous system (CNS) abnormalities that include the spinal cord and multiple brain regions. 17 We aim to describe these CNS abnormalities and discuss the range of possible neurobehavioral outcomes that can occur in individuals with