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Spinal osteotomy for severe kyphosis in children with myelomeningocele
ABSTRACTS
most
useful
posterior
97
in patients fossa
disease,
suspected raised
of having intracranial
splints
were
A true
achieved
comparison
in all 14 patients. between
the results
in
pressure, generalized encepha!opathy or metastases, and after trauma, and least useful in cases of generalized seizures and mental or behavioral abnormalities. -7. Eugene Lewis, Jr.
the newborn and in this delayed series was not found to be possible. Recurrence of the deformity, however, seems to be to a more limited degree in this later series. -_7ohn Aitken
A Method of Repair of Myelomeningocele. C. M. Bannister. Brit. J. Surg. 59:445-448
Spinal Osteotomy for Severe Kyphosis in Children With Myelomeningocele. H. 8. E&stein and R. M. Vora. J. Bone Joint Surg. 548:328-333 (May), 1972.
(June),
1972.
The method described is similar to that already widely in practice. However, one comment that should be made is that the author describes first making an incision at the junction of skin and membrane although many major centers recommend starting the incision at the junction of the plaque and membrane. This has two apparent advantages. First, it allows an accurate excision of the membrane from the plaque and thus minimal damage to the neural tissue and decreased chances of burying epithelial tissue, which may lead to inclusion dermoid formation. Second, by leaving the membrane intact until one comes to the skin closure, a more accurate assessment of the amount of tissue to be excised can be made. This is especially important in wide lesions when part of the membrane may be used in the skin closure.-J. Lari Osteotomy Excision of the Spine for Lumbar Kyphosis in Myelomeningocele. W. J. W. Sherrard and J. C. Drennan. J. Bone Joint Surg. 548:50-60 (February), 1972.
The paper reports on 16 patients in whom a spinal osteotomy was performed. In three it was done to allow a urinary diversion, in one (neonate) to allow skin closure, and in the remaining 12 for recurrent ulceration and for inability to retain an upright posture, even with callipers. The operation, described in detail, consists of removal of one, two, or three vertebral bodies with their transverse processes. Fixation is by bone chips and external splinting. It is emphasized that either a ventriculoatrial shunt should be in situ or a burr hole made before operation to prevent sudden rise of intracranial pressure. The operation is, of course, performed only on those children with total paralysis below the spinal lesion. Of the 16 patients, eight were improved, there was no change in three, and five died. The authors consider this high mortality to be acceptable considering the type of case being operated upon. -_7ohn Aitken
NEOPLASMS Results of osteotomy excision of the lumbar spine at birth in infants with myelomeningocele and kyphosis were reported by the authors in 1968. The present paper deals with a series of similar cases in which operation was delayed for various reasons until the age of 3 yr or more. The series consists of 14 children with closed myelomeningocele and with a lumbar kyphosis that had progressed since birth. This had caused skin ulceration and gross postural distortion, precluding sitting in a wheelchair and the performance of any conduit operation and making the fitting of splints difficult or impossible. Operation and management are described in detail. Complications were minimal and relief of ulceration, ability to sit in a wheelchair, and fitting of
Austrian Registry for Childhood Tumors. G. Brandesky, F. Helmer, H. Henkel, K. Karrer, W. Kovac, R. Rauhs, H. Sauer, and P. Wurnig. Ptidiat. u. Pldol. 7:235239,1972. This is a report of the first experiences of the registry, which has been in operation for more than z yr. All the pediatric surgical clinics and most of the larger pediatric clinics of Austria contributed cases. Ninety-two malignancies are analyzed.-G. Brandesky Unusual Presenting Symptoms in Neuroblastoma. J. V. Bond. Brit. Med. J. 13271328 (May), 1972.
most
useful
posterior
97
in patients fossa
disease,
suspected raised
of having intracranial
splints
were
A true
achieved
comparison
in all 14 patients. between
the results
in
pressure, generalized encepha!opathy or metastases, and after trauma, and least useful in cases of generalized seizures and mental or behavioral abnormalities. -7. Eugene Lewis, Jr.
the newborn and in this delayed series was not found to be possible. Recurrence of the deformity, however, seems to be to a more limited degree in this later series. -_7ohn Aitken
A Method of Repair of Myelomeningocele. C. M. Bannister. Brit. J. Surg. 59:445-448
Spinal Osteotomy for Severe Kyphosis in Children With Myelomeningocele. H. 8. E&stein and R. M. Vora. J. Bone Joint Surg. 548:328-333 (May), 1972.
(June),
1972.
The method described is similar to that already widely in practice. However, one comment that should be made is that the author describes first making an incision at the junction of skin and membrane although many major centers recommend starting the incision at the junction of the plaque and membrane. This has two apparent advantages. First, it allows an accurate excision of the membrane from the plaque and thus minimal damage to the neural tissue and decreased chances of burying epithelial tissue, which may lead to inclusion dermoid formation. Second, by leaving the membrane intact until one comes to the skin closure, a more accurate assessment of the amount of tissue to be excised can be made. This is especially important in wide lesions when part of the membrane may be used in the skin closure.-J. Lari Osteotomy Excision of the Spine for Lumbar Kyphosis in Myelomeningocele. W. J. W. Sherrard and J. C. Drennan. J. Bone Joint Surg. 548:50-60 (February), 1972.
The paper reports on 16 patients in whom a spinal osteotomy was performed. In three it was done to allow a urinary diversion, in one (neonate) to allow skin closure, and in the remaining 12 for recurrent ulceration and for inability to retain an upright posture, even with callipers. The operation, described in detail, consists of removal of one, two, or three vertebral bodies with their transverse processes. Fixation is by bone chips and external splinting. It is emphasized that either a ventriculoatrial shunt should be in situ or a burr hole made before operation to prevent sudden rise of intracranial pressure. The operation is, of course, performed only on those children with total paralysis below the spinal lesion. Of the 16 patients, eight were improved, there was no change in three, and five died. The authors consider this high mortality to be acceptable considering the type of case being operated upon. -_7ohn Aitken
NEOPLASMS Results of osteotomy excision of the lumbar spine at birth in infants with myelomeningocele and kyphosis were reported by the authors in 1968. The present paper deals with a series of similar cases in which operation was delayed for various reasons until the age of 3 yr or more. The series consists of 14 children with closed myelomeningocele and with a lumbar kyphosis that had progressed since birth. This had caused skin ulceration and gross postural distortion, precluding sitting in a wheelchair and the performance of any conduit operation and making the fitting of splints difficult or impossible. Operation and management are described in detail. Complications were minimal and relief of ulceration, ability to sit in a wheelchair, and fitting of
Austrian Registry for Childhood Tumors. G. Brandesky, F. Helmer, H. Henkel, K. Karrer, W. Kovac, R. Rauhs, H. Sauer, and P. Wurnig. Ptidiat. u. Pldol. 7:235239,1972. This is a report of the first experiences of the registry, which has been in operation for more than z yr. All the pediatric surgical clinics and most of the larger pediatric clinics of Austria contributed cases. Ninety-two malignancies are analyzed.-G. Brandesky Unusual Presenting Symptoms in Neuroblastoma. J. V. Bond. Brit. Med. J. 13271328 (May), 1972.