Surgical procedures in spinal dysraphism: 16 Years' experience Omurga kapanma eksikliklerinde cerrahi girisimler: 16 Yillik deneyim

Abstract

The aim of this study was to evaluate the pitfalls in diagnosis, surgical therapy and follow-up of spinal dysraphism in children. Records of 692 pediatric patients with spinal dysraphism treated between 1983 and 1998 at our department were analyzed retrospectively. While 45% were male and 55% female, the age range was 1 days to 13 months. Marriage between relatives (8.5%), drug administration during pregnancy (7.6%) and presence of dysraphism in the family (5.7%) were recorded as probable predisposing prenatal factors. While prenatal screening was performed in 53 pregnancies, only in 13 pregnancies diagnosis was made in the third trimester and none were aborted. Defect repair was performed in all patients after informing the parents for probable outcome of the disease. In 172 patients ventriculoperitoneal shunt was carried out due to hydrocephalus. Shunt dysfunction occurred in 23% of patients and required a revision procedure; ventriculostomy, valve replacement, ventriculoatrial diversion, revision of the distal end or total shunt replacement being the most common. Mortality was 7.8% between 1983-1989 and 1.4% between 1990-1998. The follow-up program was accomplished by a dedicated group consisting of members of pediatric neurology, nephrology and orthopedics departments. Only 86 of all treated patients attended this program regularly. Despite a multidisciplinary approach and great team effort not only the medical consequences but also common social, psychological and economical problems are factors resulting in an unfavourable outcome in this patient group.